Healthcare Provider Details

I. General information

NPI: 1245311687
Provider Name (Legal Business Name): TANDRA T BAKER LPC-MH, LAC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 W 57TH ST STE 103
SIOUX FALLS SD
57108-3146
US

IV. Provider business mailing address

5708 S REMINGTON PL STE 400
SIOUX FALLS SD
57108-5160
US

V. Phone/Fax

Practice location:
  • Phone: 605-530-2968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH2142
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05051221
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: