Provider Demographics
NPI:1548319866
Name:BAUGHMAN, EMELISE DIANE (MED)
Entity type:Individual
Prefix:MRS
First Name:EMELISE
Middle Name:DIANE
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:EMELISE
Other - Middle Name:DIANE
Other - Last Name:STUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:717 16TH ST., P.O. BOX 24
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826
Mailing Address - Country:US
Mailing Address - Phone:308-380-1925
Mailing Address - Fax:308-986-2374
Practice Address - Street 1:717 16TH ST.
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826
Practice Address - Country:US
Practice Address - Phone:308-380-1925
Practice Address - Fax:308-986-2374
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP251101YM0800X
NE577101YA0400X
NE2790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025842500Medicaid