Healthcare Provider Details

I. General information

NPI: 1508253196
Provider Name (Legal Business Name): KELLY BAKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 CHAMPA ST
DENVER CO
80205-2529
US

IV. Provider business mailing address

11333 MESA VERDE LN
PARKER CO
80138-3025
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-2220
  • Fax: 303-293-3977
Mailing address:
  • Phone: 303-704-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0000510
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013260
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: