Provider Demographics
NPI:1508485855
Name:BAKKER, CHRISTINA SUE (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUE
Last Name:BAKKER
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 1:10366 BRIAR CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4111
Mailing Address - Country:US
Mailing Address - Phone:217-430-3851
Mailing Address - Fax:
Practice Address - Street 1:7425 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1207
Practice Address - Country:US
Practice Address - Phone:317-474-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003495A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health