Provider Demographics
NPI:1407652100
Name:BAUER, KAITLYN R (MCMHC)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:R
Last Name:BAUER
Suffix:
Gender:
Credentials:MCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9180
Mailing Address - Country:US
Mailing Address - Phone:605-381-7670
Mailing Address - Fax:
Practice Address - Street 1:501 SE 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6831
Practice Address - Country:US
Practice Address - Phone:405-653-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health