Provider Demographics
NPI:1083678700
Name:BAKER COMMUNITY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:BAKER COMMUNITY COUNSELING SERVICES, INC.
Other - Org Name:BCCS INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:CAP, ICADC
Authorized Official - Phone:904-259-0264
Mailing Address - Street 1:213 E MACCLENNY AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2121
Mailing Address - Country:US
Mailing Address - Phone:904-259-0264
Mailing Address - Fax:904-259-0265
Practice Address - Street 1:213 E MACCLENNY AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2121
Practice Address - Country:US
Practice Address - Phone:904-259-0264
Practice Address - Fax:904-259-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0402AD048000251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare