MEDICARE: MR. LELAND GREEN BAGGETT III M.A.

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	101YM0800X	Mental Health Counselor	0800	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12477	OTHER	NC	BCBS (NC STATE EMPL.)

General Provider Information

NPI Number	:	1104087972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LELAND GREEN BAGGETT III M.A.

Provider Business Mailing Address
First Line	:	3 WOODFIN AVE
Second Line	:	SUITE B
City	:	ASHEVILLE
State	:	NC
Zip	:	28804-3033
Country	:	US
Telephone Number	:	828-252-1086
Fax Number	:	828-658-9786

Provider Business Practice Location Address
First Line	:	3 WOODFIN AVE
Second Line	:	SUITE B
City	:	ASHEVILLE
State	:	NC
Zip	:	28804-3033
Country	:	US
Telephone Number	:	828-252-1086
Fax Number	:	828-658-9786

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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