MEDICARE: CORY 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

General Provider Information

NPI Number	:	1770136921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY BAKER LPC

Provider Business Mailing Address
First Line	:	305 REGENCY PKWY STE 601
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7306
Country	:	US
Telephone Number	:	940-782-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 REGENCY PKWY STE 601
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7306
Country	:	US
Telephone Number	:	940-782-8268
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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Directions to “ CORY BAKER LPC” Practice Location

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