Provider Demographics
NPI:1417383746
Name:BAKER, MELISSA F (MA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:F
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 EATON DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1335
Mailing Address - Country:US
Mailing Address - Phone:517-930-3626
Mailing Address - Fax:
Practice Address - Street 1:855 EATON DRIVE
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854
Practice Address - Country:US
Practice Address - Phone:517-930-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI46-3595882OtherTAX ID NUMBER