=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972871440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GENE ALLEN BAKER PSY.D, HSPP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2011
-----------------------------------------------------
Last Update Date | 11/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 SPRING ST
-----------------------------------------------------
City | JEFFERSONVLLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-4480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-258-0310
-----------------------------------------------------
Fax | 812-258-0409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 645 S ROGERS ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-339-1694
-----------------------------------------------------
Fax | 812-337-2438
-----------------------------------------------------
=====================================================
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 | 35001453A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0219
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 20042705A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | F . 1100008
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------