Provider Demographics
NPI:1003137688
Name:BAKER, JUSTIN C (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 OLENTANGY RIVER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3654
Mailing Address - Country:US
Mailing Address - Phone:614-257-2069
Mailing Address - Fax:
Practice Address - Street 1:3650 OLENTANGY RIVER RD STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3654
Practice Address - Country:US
Practice Address - Phone:614-257-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005233103TC0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical