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General NPI Number Information
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NPI Number | 1962592402
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Entity Type | Individual
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Provider Name | KIMBERLY JAYE DAFFRON-BAKER LCSW,LPC-S,LMFT,LCDC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 29710 US HIGHWAY 281 N
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City | BULVERDE
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State | TX
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Zip | 78163-3107
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Country | US
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Telephone | 210-896-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 25806 SANTOLINA
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2672
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Country | US
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Telephone | 210-896-6215
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12532
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 72729
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202430
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 62456
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License Number State | TX
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