Provider Demographics
NPI:1710140918
Name:BAKER, SAMIE (EDUC SPECIALIST LCPC)
Entity Type:Individual
Prefix:MS
First Name:SAMIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:EDUC SPECIALIST LCPC
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 73
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:ID
Mailing Address - Zip Code:83332
Mailing Address - Country:US
Mailing Address - Phone:208-837-4600
Mailing Address - Fax:208-837-4646
Practice Address - Street 1:2222 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BARLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-878-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health