Provider Demographics
NPI:1366643991
Name:BAKER, ELAINE L (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N SPORT OF KINGS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7152
Mailing Address - Country:US
Mailing Address - Phone:316-733-0618
Mailing Address - Fax:316-733-5101
Practice Address - Street 1:1401 N SPORT OF KINGS CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-7152
Practice Address - Country:US
Practice Address - Phone:316-733-0618
Practice Address - Fax:316-733-5101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional