Provider Demographics
NPI:1265590665
Name:BAUER, DAVID L (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:BAUER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2518
Mailing Address - Country:US
Mailing Address - Phone:219-477-5646
Mailing Address - Fax:219-462-1579
Practice Address - Street 1:2505 VALLEY DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2518
Practice Address - Country:US
Practice Address - Phone:219-477-5646
Practice Address - Fax:219-462-1579
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000884A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health