Provider Demographics
NPI:1841387990
Name:BAKER, KETURAH (MA, MFTI)
Entity Type:Individual
Prefix:MRS
First Name:KETURAH
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, MFTI
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 1615
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251-1615
Mailing Address - Country:US
Mailing Address - Phone:323-270-5581
Mailing Address - Fax:
Practice Address - Street 1:101 S WILLOWBROOK AVE # 97
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-6607
Practice Address - Country:US
Practice Address - Phone:562-284-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108566101YM0800X
CA95405106H00000X
CA64259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health