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NPI Code Detail

MEDICARE: DOUGLAS J BAKER MFT

MEDICARE: DOUGLAS J BAKER MFT
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1588981021
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS J BAKER MFT
Provider Business Mailing Address
First Line : 2911 ADAMS AVE
Second Line : SUITE 5
City : SAN DIEGO
State : CA
Zip : 92116-1509
Country : US
Telephone Number : 619-261-9269
Fax Number : 858-408-4485
Provider Business Practice Location Address
First Line : 2911 ADAMS AVE
Second Line : SUITE 5
City : SAN DIEGO
State : CA
Zip : 92116-1509
Country : US
Telephone Number : 619-261-9269
Fax Number : 858-408-4485
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2010
Last Update Date : 12/27/2016

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