Healthcare Provider Details

I. General information

NPI: 1770002719
Provider Name (Legal Business Name): HOLLY BAKER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY FLICKINGER

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 LANSING AVE
JACKSON MI
49202-2192
US

IV. Provider business mailing address

2752 PARKSIDE BLVD
JACKSON MI
49203-5530
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-1638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: