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General NPI Number Information
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NPI Number | 1558770982
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Entity Type | Individual
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Provider Name | JUDY BAKER LCDC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 2915 S INTERSTATE 35 W
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City | BURLESON
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State | TX
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Zip | 76028-1445
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Country | US
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Telephone | 817-447-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 809 NEWPORT RD
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City | FORT WORTH
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State | TX
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Zip | 76120-2827
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Country | US
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Telephone | 214-532-9316
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9988
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License Number State | TX
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