Provider Demographics
NPI:1710636865
Name:BAKER, SAMUEL SETH
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SETH
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8173
Mailing Address - Country:US
Mailing Address - Phone:317-790-9396
Mailing Address - Fax:
Practice Address - Street 1:5250 E US HIGHWAY 36 STE 410
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7824
Practice Address - Country:US
Practice Address - Phone:317-790-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health