Individual
MRS. MALLORY LYNN BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
606 N. MULBERRY, DERBY, KS 67037
(316) 788-6464
(206) 299-1262
Mailing address
1434 S ELLIS ST, WICHITA, KS 67211-3527
(316) 204-1584
(206) 299-1262
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1054
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200574520A
—
KS
Enumeration date
08/20/2008
Last updated
08/26/2009
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