Provider Demographics
NPI:1083845267
Name:BAKER, MICHELLE N (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:BAKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1002
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:1250 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1002
Practice Address - Country:US
Practice Address - Phone:510-655-7880
Practice Address - Fax:510-655-3379
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist