Provider Demographics
NPI:1407277445
Name:BAKER, ELLEN BURT (LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:BURT
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SHILOH RD NW
Mailing Address - Street 2:SUITE 2770
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7175
Mailing Address - Country:US
Mailing Address - Phone:678-449-9715
Mailing Address - Fax:
Practice Address - Street 1:1275 SHILOH RD NW
Practice Address - Street 2:SUITE 2770
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7175
Practice Address - Country:US
Practice Address - Phone:678-449-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional