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NPI 1639593957

NPI 1639593957 : HEATH AARON BAKER LMSW : NEVADA, MO

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General NPI Number Information
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    NPI Number           |    1639593957
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    Entity Type          |    Individual 
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    Provider Name        |    HEATH AARON BAKER LMSW
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    02/06/2014
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    Last Update Date     |    02/06/2014
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Provider Practice Location Address
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    Address Line         |    1500 W ASHLAND ST 
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    City                 |    NEVADA
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    State                |    MO
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    Zip                  |    64772-1710
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    Country              |    US
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    Telephone            |    417-667-2666
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    Fax                  |    417-448-5604
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Provider Business Mailing Address
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    Address Line         |    1500 W ASHLAND ST 
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    City                 |    NEVADA
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    State                |    MO
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    Zip                  |    64772-1710
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    Country              |    US
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    Telephone            |    417-667-2666
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    Fax                  |    417-448-5604
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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        |    1041C0700X
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    Taxonomy Name        |    Clinical Social Worker
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    License Number       |    2013040981
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    License Number State |    MO
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