MEDICARE: WENDY LYNNE BAKER LMFT

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	106H00000X	Marriage & Family Therapist	MFC34834	CA

General Provider Information

NPI Number	:	1942225917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY LYNNE BAKER LMFT

Provider Business Mailing Address
First Line	:	77564 COUNTRY CLUB DR
Second Line	:	BLDG. A, STE. 214
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0484
Country	:	US
Telephone Number	:	760-668-0906
Fax Number	:	760-360-9851

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR
Second Line	:	BLDG. A, STE. 214
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0484
Country	:	US
Telephone Number	:	760-668-0906
Fax Number	:	760-360-9851

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/01/2008

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