=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669037867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ELIZABETH BAKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2019
-----------------------------------------------------
Last Update Date | 07/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9441 DOUBLE DIAMOND PKWY STE 13
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-8948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-458-1510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9441 DOUBLE DIAMOND PKWY STE 13
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-8948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-458-1510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MI2784
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 4327
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------