Provider Demographics
NPI:1144805763
Name:COOVERT-BAKER, DEBORAH SUSAN (RADT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUSAN
Last Name:COOVERT-BAKER
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 N CHRISDEN ST APT Q104
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2208
Mailing Address - Country:US
Mailing Address - Phone:714-936-9765
Mailing Address - Fax:
Practice Address - Street 1:1265 N CHRISDEN ST APT Q104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2208
Practice Address - Country:US
Practice Address - Phone:714-936-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1340590319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)