MEDICARE: CRAIG BAKER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1112908-3904	UT
2	106H00000X	Marriage & Family Therapist	11129018-3902	UT

General Provider Information

NPI Number	:	1184250300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG BAKER MFT

Provider Business Mailing Address
First Line	:	265 S WOODLAND HILLS DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653-2003
Country	:	US
Telephone Number	:	925-565-6414
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 S WOODLAND HILLS DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653-2003
Country	:	US
Telephone Number	:	925-565-6414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/23/2022

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