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General NPI Number Information
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NPI Number | 1649593070
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Entity Type | Individual
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Provider Name | CAROLE MARTHA BAKER M.S., LICENSED MFT
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Gender | Female
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 1515 FAIRVIEW AVE STE 235
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City | MISSOULA
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State | MT
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Zip | 59801-7821
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Country | US
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Telephone | 406-532-1572
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Fax | 406-532-1541
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Provider Business Mailing Address
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Address Line | 10516 NEZ PERCE LOOP
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City | LOLO
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State | MT
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Zip | 59847-8477
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Country | US
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Telephone | 406-564-0037
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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 | 7
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License Number State | MT
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