Provider Demographics
NPI:1871128819
Name:BAUMGARTNER, TOM P (LMFT)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:P
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3715
Mailing Address - Country:US
Mailing Address - Phone:507-354-3181
Mailing Address - Fax:507-354-3183
Practice Address - Street 1:716 SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MN
Practice Address - Zip Code:55334-2386
Practice Address - Country:US
Practice Address - Phone:507-237-9989
Practice Address - Fax:507-237-2027
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLMFT3987OtherSTATE LICENSE