Healthcare Provider Details

I. General information

NPI: 1942703459
Provider Name (Legal Business Name): DEBORAH IRENE SINNETTE-BAIRD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBY SINNETTE-BAIRD

II. Dates (important events)

Enumeration Date: 03/11/2018
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date: 07/30/2019
Reactivation Date: 08/09/2019

III. Provider practice location address

482 N ROSEMEAD BLVD
PASADENA CA
91107-3000
US

IV. Provider business mailing address

250 MADELINE DR
MONROVIA CA
91016-2432
US

V. Phone/Fax

Practice location:
  • Phone: 626-708-0049
  • Fax:
Mailing address:
  • Phone: 626-708-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: