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General NPI Number Information
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NPI Number | 1962590646
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Entity Type | Individual
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Provider Name | LISA MARIE HANKS BAXTER L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 129 E ST SUITE C-3
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City | DAVIS
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State | CA
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Zip | 95616-4658
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Country | US
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Telephone | 530-753-1309
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Fax | 530-758-0864
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Provider Business Mailing Address
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Address Line | 129 E ST SUITE C-3
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City | DAVIS
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State | CA
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Zip | 95616-4658
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Country | US
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Telephone | 530-753-1309
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Fax | 530-758-0864
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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 | LCS10124
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License Number State | CA
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