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NPI Code Detail

MEDICARE: CAROL BAUSTERT M.S. , L.P.C.

MEDICARE: CAROL BAUSTERT M.S. , L.P.C.
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
1101Y00000XCounselor2182OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17944221OTHEROKAETNA INSURANCE

General Provider Information

NPI Number : 1770526543
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL BAUSTERT M.S. , L.P.C.
Provider Business Mailing Address
First Line : 3508 NW 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-5630
Country : US
Telephone Number : 405-943-1281
Fax Number : 405-943-1281
Provider Business Practice Location Address
First Line : 3508 NW 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-5630
Country : US
Telephone Number : 405-943-1281
Fax Number : 405-943-1281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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