MEDICARE: KELLY BAEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC005763	GA

General Provider Information

NPI Number	:	1093046385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BAEZ

Provider Business Mailing Address
First Line	:	2028 CHEROKEE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-1005
Country	:	US
Telephone Number	:	706-888-4319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 CHEROKEE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-1005
Country	:	US
Telephone Number	:	706-888-4319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	06/24/2025

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Directions to “ KELLY BAEZ ” Practice Location

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