MEDICARE: ELLEN BAUGHMAN LMFT

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	MT3884	FL

General Provider Information

NPI Number	:	1144821802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN BAUGHMAN LMFT

Provider Business Mailing Address
First Line	:	878 PLEASURE BAY DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5673
Country	:	US
Telephone Number	:	904-982-0455
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 SUTTON PARK DR S STE 702
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5290
Country	:	US
Telephone Number	:	904-247-2179
Fax Number	:

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

Provider Enumeration Date	:	11/07/2020
Last Update Date	:	11/07/2020

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