Provider Demographics
NPI:1558436238
Name:BAKER, KATHY J (LMHP CPC MSE)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHP CPC MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N COLFAX ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1559
Mailing Address - Country:US
Mailing Address - Phone:402-372-9122
Mailing Address - Fax:402-372-9123
Practice Address - Street 1:120 N COLFAX ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1559
Practice Address - Country:US
Practice Address - Phone:402-372-9122
Practice Address - Fax:402-372-9123
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2335101Y00000X
NE1294101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
84049OtherBLUE CROSS BLUE SHIELD
489211000OtherMAGELLAN
489211000OtherMAGELLAN