Provider Demographics
NPI:1699112532
Name:BAUER, CODY (MS, LMHC, CAP)
Entity type:Individual
Prefix:MRS
First Name:CODY
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MS, LMHC, CAP
Other - Prefix:MISS
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:GOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15311 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15311 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6005
Practice Address - Country:US
Practice Address - Phone:352-540-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5950101YA0400X
FLIMH 9990101YM0800X
FLMH12651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012480900Medicaid