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1538302054

NPI Code Detail

MEDICARE: MR. MARC WERNER BAISDEN MA, CMHC, MSCP, CIS

MEDICARE: MR. MARC WERNER BAISDEN MA, CMHC, MSCP, CIS

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	CL60147106	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CL60147106	WA
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538302054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC WERNER BAISDEN MA, CMHC, MSCP, CIS

Provider Business Mailing Address
First Line	:	1600 WEEOT WAY
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-4734
Country	:	US
Telephone Number	:	707-825-5000
Fax Number	:	707-825-6747

Provider Business Practice Location Address
First Line	:	1675 NORTHCREST DR
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-8928
Country	:	US
Telephone Number	:	707-464-2750
Fax Number	:	707-464-2668

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	05/19/2023

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Directions to “ MR. MARC WERNER BAISDEN MA, CMHC, MSCP, CIS” Practice Location

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