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NPI Code Detail

MEDICARE: MR. JASON TODD BAKER M.A., LPC

MEDICARE: MR. JASON TODD BAKER M.A., 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
1101YM0800XMental Health Counselor17529TX

General Provider Information

NPI Number : 1891703096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON TODD BAKER M.A., LPC
Provider Business Mailing Address
First Line : 5751 PARK VISTA CIR STE 101
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5693
Country : US
Telephone Number : 817-812-2880
Fax Number : 817-812-3096
Provider Business Practice Location Address
First Line : 3910 W INTERSTATE 20 STE 100
Second Line :
City : ARLINGTON
State : TX
Zip : 76017-1430
Country : US
Telephone Number : 817-812-2880
Fax Number : 817-812-3096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 02/06/2026

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