Provider Demographics
NPI:1154627644
Name:BAKER, PATRICIA MAREE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MAREE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MAREE
Other - Last Name:HARTLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 TEXAS BOULEVARD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501
Mailing Address - Country:US
Mailing Address - Phone:430-342-2246
Mailing Address - Fax:888-381-3839
Practice Address - Street 1:1001 TEXAS BLVD.
Practice Address - Street 2:SUITE 106
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:430-342-2246
Practice Address - Fax:888-381-3839
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional