Provider Demographics
NPI:1790115715
Name:BAER, NITA DEBRA (MA)
Entity Type:Individual
Prefix:MS
First Name:NITA
Middle Name:DEBRA
Last Name:BAER
Suffix:
Gender:F
Credentials:MA
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 2045
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0939
Mailing Address - Country:US
Mailing Address - Phone:360-620-0133
Mailing Address - Fax:
Practice Address - Street 1:4001 NE LOOKOUT LN
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8872
Practice Address - Country:US
Practice Address - Phone:360-620-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60394138101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor