MEDICARE: MR. CANAAN BAKER MA, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	94965	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15754	TX

General Provider Information

NPI Number	:	1043943558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CANAAN BAKER MA, LCDC

Provider Business Mailing Address
First Line	:	3723 GREENVILLE AVE STE 71598
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5311
Country	:	US
Telephone Number	:	972-360-9002
Fax Number	:	972-947-5167

Provider Business Practice Location Address
First Line	:	3723 GREENVILLE AVE STE 71598
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5311
Country	:	US
Telephone Number	:	972-360-9002
Fax Number	:	972-947-5167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2022
Last Update Date	:	03/05/2026

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