Healthcare Provider Details

I. General information

NPI: 1427583939
Provider Name (Legal Business Name): CHRISTINE BAKER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 NW 157TH CT
MORRISTON FL
32668-7742
US

IV. Provider business mailing address

4604 NW 157TH CT
MORRISTON FL
32668-7742
US

V. Phone/Fax

Practice location:
  • Phone: 352-595-5000
  • Fax:
Mailing address:
  • Phone: 352-595-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: