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General NPI Number Information
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NPI Number | 1225404973
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Entity Type | Individual
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Provider Name | TAMARA KATRINA BAKER M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1309 PONDEROSA DR STE 203
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City | SANDPOINT
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State | ID
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Zip | 83864-8278
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Country | US
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Telephone | 208-278-6027
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Fax |
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Provider Business Mailing Address
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Address Line | 176 CROOKED LN
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City | SANDPOINT
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State | ID
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Zip | 83864-9213
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Country | US
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Telephone | 208-278-6027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF88283
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License Number State | CA
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