Provider Demographics
NPI:1861633737
Name:BAKER, ROBERT GEORGE JR (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GEORGE
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1611 116TH AVE NE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3045
Mailing Address - Country:US
Mailing Address - Phone:425-451-0335
Mailing Address - Fax:425-451-0340
Practice Address - Street 1:1611 116TH AVE NE
Practice Address - Street 2:SUITE 123
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3045
Practice Address - Country:US
Practice Address - Phone:425-451-0335
Practice Address - Fax:425-451-0340
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003917101YM0800X
WALF00001022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health