Provider Demographics
NPI:1659544393
Name:BAKER, VAUGHN L (MFTI)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ESTUDILLO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4639
Mailing Address - Country:US
Mailing Address - Phone:510-357-0550
Mailing Address - Fax:510-357-1331
Practice Address - Street 1:525 ESTUDILLO AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4639
Practice Address - Country:US
Practice Address - Phone:510-357-0550
Practice Address - Fax:510-357-1331
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 46850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist