Provider Demographics
NPI:1114937471
Name:BAKER, SAMUEL THOMAS (MDIV)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:BAKER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 BAKER CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2677
Mailing Address - Country:US
Mailing Address - Phone:615-443-2730
Mailing Address - Fax:615-443-6911
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:#125
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-327-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral