Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 103TF0200X | Forensic Psychologist | ||
Y | 103TS0200X | School Psychologist |
NPI | 1033699129 |
---|---|
Provider Name | Sherry Bauman |
First Address | Kelseyville, CA 95451-8249 |
Second Address | Clearlake, CA 95422-9381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |