Healthcare Provider Details

I. General information

NPI: 1770636706
Provider Name (Legal Business Name): STEVEN EDWARD BAKER LPC, CAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 NE CONNERS AVE SUITE 280
BEND OR
97701-7753
US

IV. Provider business mailing address

600 SW COLUMBIA ST SUITE 6210
BEND OR
97702-1099
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-4269
  • Fax: 541-383-1883
Mailing address:
  • Phone: 541-383-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3793
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: