| Doctor Name: | DR. MONTY TIMOTHY BAKER |
| NPI Number: | 1053308528 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PY 7200 |
| Business Practice Address: | 2200 Bergquist Dr Ste. 1, Life Skills Support Center, 59 Mdos Mmcm Lackland A F B, TX - 782369907 |
| Business Phone Number: | 2102927361 |
| Business Fax Number: | 2102922520 |
| Mailing Address: | 2200 Bergquist Dr, Ste. 1, Life Skills Support Center, 59 Mdos Mmcm LACKLAND A F B |
| State: | TX |
| Postal Code: | 782369907 |
| Phone Number: | 2102927361 |
| Fax Number: | 2102922520 |
| NPI Enumeration Date: | 09/30/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY 7200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |