Provider Demographics
NPI:1003216060
Name:BAEK, HAEWON GRACE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:HAEWON
Middle Name:GRACE
Last Name:BAEK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:HYE
Other - Middle Name:WON
Other - Last Name:BAEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15632 W 79TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7810
Mailing Address - Country:US
Mailing Address - Phone:970-400-1964
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DR STE 311
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4112
Practice Address - Country:US
Practice Address - Phone:970-400-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98855106H00000X
CO1657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist