Provider Demographics
NPI:1114237740
Name:BAKER, KRISTIE DIANE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:DIANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:DIANE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:126 MOUNT ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-835-1594
Mailing Address - Fax:775-201-4932
Practice Address - Street 1:126 MOUNT ROSE ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3352
Practice Address - Country:US
Practice Address - Phone:775-835-1594
Practice Address - Fax:775-201-4932
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist