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General NPI Number Information
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NPI Number | 1770805392
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Entity Type | Organization
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Legal Business Name | BAKER CARMICHAEL COUNSELING CENTER
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 900 WHITEHEAD DR
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City | GRANBURY
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State | TX
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Zip | 76048-2505
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Country | US
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Telephone | 817-573-6922
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Fax | 817-579-6611
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Provider Business Mailing Address
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Address Line | 900 WHITEHEAD DR P O BOX 758
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City | GRANBURY
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State | TX
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Zip | 76048-2505
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Country | US
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Telephone | 817-573-6922
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Fax | 817-579-6611
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MS. CLAUDIA P SOUTHERN
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Credential | LPC/MED
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Telephone | 817-573-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13881
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License Number State | TX
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