Healthcare Provider Details

I. General information

NPI: 1588369748
Provider Name (Legal Business Name): ANNY BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 ANDERSON RD STE D
DAVIS CA
95616-0676
US

IV. Provider business mailing address

2020 5TH ST UNIT 509
DAVIS CA
95617-7029
US

V. Phone/Fax

Practice location:
  • Phone: 530-918-4093
  • Fax:
Mailing address:
  • Phone: 530-613-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135257
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: