Provider Demographics
NPI:1508171471
Name:BAKER, TANYA MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1610
Mailing Address - Country:US
Mailing Address - Phone:812-917-3186
Mailing Address - Fax:812-917-4260
Practice Address - Street 1:1537 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1610
Practice Address - Country:US
Practice Address - Phone:812-917-3186
Practice Address - Fax:812-917-4260
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health