Provider Demographics
NPI:1952829459
Name:BAKER, MEGAN G (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:G
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 S CLOVERDALE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2891
Mailing Address - Country:US
Mailing Address - Phone:323-533-1613
Mailing Address - Fax:
Practice Address - Street 1:3575 CAHUENGA BLVD W STE 575
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3095
Practice Address - Country:US
Practice Address - Phone:323-547-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty