Provider Demographics
NPI:1063248078
Name:BAUMANN, ELIZABETH LAIRD (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAIRD
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LAIRD
Other - Last Name:COULSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11022 RED BUD TRL
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9625
Mailing Address - Country:US
Mailing Address - Phone:574-261-4532
Mailing Address - Fax:
Practice Address - Street 1:11022 RED BUD TRL
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9625
Practice Address - Country:US
Practice Address - Phone:574-261-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009891A1041C0700X
MI68011141091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical