Provider Demographics
NPI:1649593070
Name:BAKER, CAROLE MARTHA (MS, LICENSED MFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:MARTHA
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 NEZ PERCE LOOP
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8477
Mailing Address - Country:US
Mailing Address - Phone:406-564-0037
Mailing Address - Fax:
Practice Address - Street 1:1515 FAIRVIEW AVE STE 235
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7821
Practice Address - Country:US
Practice Address - Phone:406-532-1572
Practice Address - Fax:406-532-1541
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist