Doctor Name: | JOHN R BAKER |
NPI Number: | 1114369485 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C. |
License Number: | 17302 |
Business Practice Address: | 209 Shade Tree St Highland Village, TX - 750776938 |
Business Phone Number: | 9403687051 |
Business Fax Number: | |
Mailing Address: | 209 Shade Tree St, HIGHLAND VILLAGE |
State: | TX |
Postal Code: | 750776938 |
Phone Number: | 9403687051 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2013 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 17302 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |