Healthcare Provider Details

I. General information

NPI: 1558053140
Provider Name (Legal Business Name): SUSAN BAKER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

IV. Provider business mailing address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax:
Mailing address:
  • Phone: 360-330-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61666442
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: