Provider Demographics
NPI:1093018558
Name:BAKER, TRACY LEIGH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
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:RR 4 BOX 38
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-9302
Mailing Address - Country:US
Mailing Address - Phone:918-519-0062
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 38
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-9302
Practice Address - Country:US
Practice Address - Phone:918-519-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health