Provider Demographics
NPI:1134650872
Name:BAKER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:140 REDWOOD LN
Practice Address - Street 2:PINEHILLS SUBDIVISION
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-9190
Practice Address - Country:US
Practice Address - Phone:606-784-2790
Practice Address - Fax:606-784-2790
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor