Provider Demographics
NPI:1316795735
Name:BAISINGER, KAREN LOVE (DMIN)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LOVE
Last Name:BAISINGER
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 FIR ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-3509
Mailing Address - Country:US
Mailing Address - Phone:541-915-0335
Mailing Address - Fax:541-982-7030
Practice Address - Street 1:180 S EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3352
Practice Address - Country:US
Practice Address - Phone:541-915-0335
Practice Address - Fax:541-982-7030
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHPC-001468101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty