Provider Demographics
NPI:1154967016
Name:BAUMGARTNER, MATTHEW STEWART (LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEWART
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W DIVIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1220
Mailing Address - Country:US
Mailing Address - Phone:701-368-8418
Mailing Address - Fax:
Practice Address - Street 1:6301 19TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-8899
Practice Address - Country:US
Practice Address - Phone:701-852-3628
Practice Address - Fax:701-852-1190
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1039-11-19101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional