Healthcare Provider Details

I. General information

NPI: 1154928877
Provider Name (Legal Business Name): TYLER RAY-BAKER LCSW, LCASA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 GRANDE VALLEY CIR
CARY NC
27513-3143
US

IV. Provider business mailing address

3125 POPLARWOOD CT STE 203
RALEIGH NC
27604-6445
US

V. Phone/Fax

Practice location:
  • Phone: 919-756-2105
  • Fax:
Mailing address:
  • Phone: 919-787-6131
  • Fax: 919-571-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020201
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: