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General NPI Number Information
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NPI Number | 1538337993
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Entity Type | Individual
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Provider Name | JOHN BAKER LPC
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Gender | Male
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 214 OAKLEIGH DR
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City | BOONEVILLE
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State | MS
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Zip | 38829-8241
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Country | US
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Telephone | 662-523-0579
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Fax |
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Provider Business Mailing Address
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Address Line | 214 OAKLEIGH DR
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City | BOONEVILLE
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State | MS
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Zip | 38829-8241
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Country | US
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Telephone | 662-523-0579
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Fax | 662-286-8095
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1330
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License Number State | MS
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