Healthcare Provider Details

I. General information

NPI: 1124647433
Provider Name (Legal Business Name): BAKKER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 E 86TH ST
INDIANAPOLIS IN
46256-1207
US

IV. Provider business mailing address

10366 BRIAR CREEK PL
CARMEL IN
46033-4111
US

V. Phone/Fax

Practice location:
  • Phone: 317-474-6448
  • Fax:
Mailing address:
  • Phone: 217-430-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA SUE BAKKER
Title or Position: OWNER/MENTAL HEALTH THERAPIST
Credential: LMHC
Phone: 217-430-3851