Provider Demographics
NPI:1568648202
Name:BAKER, BRENDA S (LPC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:S
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 1:3501 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1351
Mailing Address - Country:US
Mailing Address - Phone:719-568-3611
Mailing Address - Fax:719-544-4562
Practice Address - Street 1:902 W 29TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1159
Practice Address - Country:US
Practice Address - Phone:719-568-3611
Practice Address - Fax:719-544-4562
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC #2462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional