Provider Demographics
NPI:1023628567
Name:BAUMCHEN, KRISTINE (LMSW, LMAC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BAUMCHEN
Suffix:
Gender:F
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 NAISMITH DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-4069
Mailing Address - Country:US
Mailing Address - Phone:785-393-5015
Mailing Address - Fax:
Practice Address - Street 1:1651 NAISMITH DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-4069
Practice Address - Country:US
Practice Address - Phone:785-393-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS871101YA0400X
KS50531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty