| Doctor Name: | KELLY BAUER |
| NPI Number: | 1023199973 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 11200 Waples Mill Rd Suite 180 Fairfax, VA - 220307407 |
| Business Phone Number: | 7033838333 |
| Business Fax Number: | 7033833183 |
| Mailing Address: | 2099 N Collins Blvd, Suite 100 RICHARDSON |
| State: | TX |
| Postal Code: | 750802698 |
| Phone Number: | 9724374698 |
| Fax Number: | 9726712087 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |