Provider Demographics
NPI:1831126903
Name:BAKER, VAUNETTE L (LPP (LICENSED PSYCHO)
Entity Type:Individual
Prefix:
First Name:VAUNETTE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPP (LICENSED PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SOUTHPORT DR.
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-677-0053
Mailing Address - Fax:606-677-0060
Practice Address - Street 1:106 SOUTHPORT DR.
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-677-0053
Practice Address - Fax:606-677-0060
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83101YM0800X
KY0068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health