Provider Demographics
NPI:1730516295
Name:BAUCOM BEHAVIORAL & EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:BAUCOM BEHAVIORAL & EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:BAUCOM
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:512-537-3014
Mailing Address - Street 1:PO BOX 26642
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0642
Mailing Address - Country:US
Mailing Address - Phone:512-537-3014
Mailing Address - Fax:
Practice Address - Street 1:700 LAVACA ST
Practice Address - Street 2:STE 1401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3101
Practice Address - Country:US
Practice Address - Phone:512-537-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12198251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health