Provider Demographics
NPI:1194957142
Name:BAIRD, AMY (LPP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1177
Mailing Address - Country:US
Mailing Address - Phone:270-904-6567
Mailing Address - Fax:270-904-6570
Practice Address - Street 1:1910 LYDA AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3326
Practice Address - Country:US
Practice Address - Phone:270-904-6567
Practice Address - Fax:270-904-6570
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid