Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | 39000055A | IN |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 39000055A | IN |
NPI | 1346442258 |
---|---|
Provider Name | Dr. Joseph R Baunoch SR. |
First Address | Port Huron, MI 48060-6533 |
Second Address | Yale, MI 48097-3316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 07/09/2020 |