MEDICARE: MS. PONCIE BAKER

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

General Provider Information

NPI Number	:	1184254740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PONCIE BAKER

Provider Business Mailing Address
First Line	:	8840 VALENCIA OAKS CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3495
Country	:	US
Telephone Number	:	717-514-0287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4740
Country	:	US
Telephone Number	:	717-514-0287
Fax Number	:

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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