Provider Demographics
NPI:1356581102
Name:CHRIS BAUER PH.D. LLC
Entity type:Organization
Organization Name:CHRIS BAUER PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-507-0680
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9003
Mailing Address - Country:US
Mailing Address - Phone:703-507-0680
Mailing Address - Fax:
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 3500
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:703-507-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV955103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty