Provider Demographics
NPI:1033847645
Name:BAKER, LYNDSAY ERIN
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:ERIN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 BRUSH ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1719
Mailing Address - Country:US
Mailing Address - Phone:606-215-6173
Mailing Address - Fax:
Practice Address - Street 1:386 BRUSH ARBOR RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1719
Practice Address - Country:US
Practice Address - Phone:606-215-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY264283Medicaid