Healthcare Provider Details

I. General information

NPI: 1710014873
Provider Name (Legal Business Name): EARL H. BAKER PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 STUBBS AVE
MONROE LA
71201-5628
US

IV. Provider business mailing address

1502 STUBBS AVE
MONROE LA
71201-5628
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8700
  • Fax: 318-323-8757
Mailing address:
  • Phone: 318-323-8700
  • Fax: 318-323-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMP577
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.000577
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: