Provider Demographics
NPI:1609962554
Name:BAIER, PHILLIP (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BAIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 QUIET SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5752
Mailing Address - Country:US
Mailing Address - Phone:702-689-1301
Mailing Address - Fax:
Practice Address - Street 1:2780 S JONES BLVD STE 135
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5641
Practice Address - Country:US
Practice Address - Phone:702-689-1301
Practice Address - Fax:702-893-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4035-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508014Medicaid