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NPI Code Detail

MEDICARE: GARY BAKER LCSW

MEDICARE: GARY BAKER LCSW
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
1104100000XSocial Worker3453LA

General Provider Information

NPI Number : 1689603912
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY BAKER LCSW
Provider Business Mailing Address
First Line : 6240 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71119-8413
Country : US
Telephone Number : 318-632-2010
Fax Number : 318-632-2055
Provider Business Practice Location Address
First Line : 6240 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71119-8413
Country : US
Telephone Number : 318-632-2010
Fax Number : 318-632-2055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/08/2007

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1750310132 — PAUL M SEALE MSW, LCSW
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1891725487 — CATHY WALKER LCSW
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Directions to “ GARY BAKER LCSW” Practice Location

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