Provider Demographics
NPI:1386228278
Name:BAKER, JEFFREY P (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 MORADO CV APT 262
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5663
Mailing Address - Country:US
Mailing Address - Phone:570-801-2489
Mailing Address - Fax:
Practice Address - Street 1:1101 SATELLITE VW UNIT 603
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1592
Practice Address - Country:US
Practice Address - Phone:512-212-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85794101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor