Healthcare Provider Details

I. General information

NPI: 1104168053
Provider Name (Legal Business Name): PETER BAAKO M.S, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 SUTTON RD
CINCINNATI OH
45230-3521
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 515-231-5010
  • Fax:
Mailing address:
  • Phone: 513-741-3100
  • Fax: 513-741-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2204430
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: