MEDICARE: MR. RICHARD L BALDWIN MA/LPC

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	101Y00000X	Counselor	6401004088	MI
2	101YP2500X	Professional Counselor	6401004088	MI

General Provider Information

NPI Number	:	1992313142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD L BALDWIN MA/LPC

Provider Business Mailing Address
First Line	:	6564 GRAND RIVER RD.
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277
Country	:	US
Telephone Number	:	517-569-8467
Fax Number	:

Provider Business Practice Location Address
First Line	:	6564 GRAND RIVER RD.
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277
Country	:	US
Telephone Number	:	517-569-8467
Fax Number	:

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	05/12/2021

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