Provider Demographics
NPI:1245387828
Name:BAIZE, ROBERT DOUGLAS (CDP, NCAC I, MHP,)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:BAIZE
Suffix:
Gender:M
Credentials:CDP, NCAC I, MHP,
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 653
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-0653
Mailing Address - Country:US
Mailing Address - Phone:425-349-8226
Mailing Address - Fax:425-349-8230
Practice Address - Street 1:431 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1460
Practice Address - Country:US
Practice Address - Phone:812-384-9452
Practice Address - Fax:812-384-9445
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005724101YA0400X
WALH00005969101YM0800X
IN39003718A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)