Healthcare Provider Details

I. General information

NPI: 1720924467
Provider Name (Legal Business Name): LILY WU BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILY WU

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 E ADAMO DR STE 238-B
TAMPA FL
33605-5919
US

IV. Provider business mailing address

4951 E ADAMO DR STE 238-B
TAMPA FL
33605-5919
US

V. Phone/Fax

Practice location:
  • Phone: 727-309-1413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: