Provider Demographics
NPI:1003244609
Name:BAKER, KRISTIAN S (LMFT)
Entity Type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:S
Last Name:BAKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S STATE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1116
Mailing Address - Country:US
Mailing Address - Phone:801-855-7999
Mailing Address - Fax:801-855-7999
Practice Address - Street 1:129 S STATE ST STE 250
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1116
Practice Address - Country:US
Practice Address - Phone:801-855-7999
Practice Address - Fax:801-855-7999
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8541686-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist