Healthcare Provider Details

I. General information

NPI: 1891947008
Provider Name (Legal Business Name): CARRIE LEE SOCHA BAIRD MASTERS DEGREE MARRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 PARK AVE
COOS BAY OR
97420-2244
US

IV. Provider business mailing address

2180 SOUTHWEST BLVD
COOS BAY OR
97420-9218
US

V. Phone/Fax

Practice location:
  • Phone: 541-995-7220
  • Fax:
Mailing address:
  • Phone: 208-479-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3416
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92344
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: