Healthcare Provider Details

I. General information

NPI: 1740335835
Provider Name (Legal Business Name): TINA RAE BAKER-SQUIER BS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10295 W KEENE AVE
LAKEWOOD CO
80235-1104
US

IV. Provider business mailing address

352 ENGLISH SPARROW DR
HIGHLANDS RANCH CO
80129-5645
US

V. Phone/Fax

Practice location:
  • Phone: 303-980-4082
  • Fax:
Mailing address:
  • Phone: 303-432-5432
  • Fax:

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: