Provider Demographics
NPI:1689648867
Name:BAKER, ANDREA J II (LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BAKER
Suffix:II
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-0129
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD
Practice Address - Street 2:SUITE F
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1072
Practice Address - Country:US
Practice Address - Phone:317-468-6200
Practice Address - Fax:317-468-6201
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000537A101YM0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7755121OtherAETNA PIN#
IN200459330AMedicaid
IN000000246602OtherANTHEM PIN#
INE74049Medicare UPIN