MEDICARE: MICHAEL P BAKER DBA ASSOCIATES FOR PSYCHOLOIGCAL & THERAPY SERVICES

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	101YM0800X	Mental Health Counselor	00199	IA
2	104100000X	Social Worker	01389	IA
3	1041C0700X	Clinical Social Worker	04698	IA
4	103T00000X	Psychologist	453	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174799225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL P BAKER DBA ASSOCIATES FOR PSYCHOLOIGCAL & THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1551 INDIAN HILLS DR
Second Line	:	SUITE 221
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1859
Country	:	US
Telephone Number	:	712-252-1473
Fax Number	:	712-252-5672

Provider Business Practice Location Address
First Line	:	1551 INDIAN HILLS DR
Second Line	:	SUITE 221
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1859
Country	:	US
Telephone Number	:	712-252-1473
Fax Number	:	712-252-5672

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	MICHAEL P BAKER
Credential	:	PHD
Telephone Number	:	712-252-1473

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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