Healthcare Provider Details

I. General information

NPI: 1033576749
Provider Name (Legal Business Name): CHRISTOPHER JOHN BACKER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8839 BRYAN DAIRY RD STE 310
LARGO FL
33777-1207
US

IV. Provider business mailing address

300 CYPRESS CREEK CIR
OLDSMAR FL
34677-2007
US

V. Phone/Fax

Practice location:
  • Phone: 396-906-9062
  • Fax:
Mailing address:
  • Phone: 175-072-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: