MEDICARE: DAVID CONRAD BAKER LPC

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	LPC006479	GA

General Provider Information

NPI Number	:	1487809992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CONRAD BAKER LPC

Provider Business Mailing Address
First Line	:	1414 DUG GAP RD
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-5007
Country	:	US
Telephone Number	:	706-279-0405
Fax Number	:	706-279-4190

Provider Business Practice Location Address
First Line	:	1267 MOUNT OLIVE RD
Second Line	:
City	:	LOOKOUT MOUNTAIN
State	:	GA
Zip	:	30750-2930
Country	:	US
Telephone Number	:	706-639-5900
Fax Number	:

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

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/08/2016

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Directions to “ DAVID CONRAD BAKER LPC” Practice Location

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