Provider Demographics
NPI:1891947008
Name:BAIRD, CARRIE LEE SOCHA (MASTERS DEGREE MARRI)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LEE SOCHA
Last Name:BAIRD
Suffix:
Gender:F
Credentials:MASTERS DEGREE MARRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WILSON AVE SUITE 5
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-915-8448
Mailing Address - Fax:208-240-9257
Practice Address - Street 1:611 WILSON AVE SUITE 5
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-915-8448
Practice Address - Fax:208-240-9257
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA92344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner