Provider Demographics
NPI:1811383672
Name:BAKKE, PAUL CHRISTOPHER (LCP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:BAKKE
Suffix:
Gender:M
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SHONEY DR SW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5436
Mailing Address - Country:US
Mailing Address - Phone:256-883-3231
Mailing Address - Fax:256-883-9577
Practice Address - Street 1:810 SHONEY DR SW
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5436
Practice Address - Country:US
Practice Address - Phone:256-883-3231
Practice Address - Fax:256-883-9577
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health