Healthcare Provider Details

I. General information

NPI: 1538818059
Provider Name (Legal Business Name): BENJAMIN BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 HELLING WAY
NEVADA CITY CA
95959-8619
US

IV. Provider business mailing address

16920 LOG CABIN TRL
GRASS VALLEY CA
95945-8410
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-7222
  • Fax:
Mailing address:
  • Phone: 530-567-9544
  • Fax: 530-265-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: