Provider Demographics
NPI:1730349887
Name:BAISCH, RICHARD ALLEN (LPC LLP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:BAISCH
Suffix:
Gender:M
Credentials:LPC LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MILLARD STREET
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9590
Mailing Address - Country:US
Mailing Address - Phone:269-279-5187
Mailing Address - Fax:269-273-2083
Practice Address - Street 1:1020 MILLARD STREET
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9590
Practice Address - Country:US
Practice Address - Phone:269-279-5187
Practice Address - Fax:269-273-2083
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010698101Y00000X
MI6301006145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist