Provider Demographics
NPI:1972003317
Name:BAKER, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
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 232
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72944-0232
Mailing Address - Country:US
Mailing Address - Phone:479-739-5366
Mailing Address - Fax:
Practice Address - Street 1:100 N WALNUT AVE STE C
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:AR
Practice Address - Zip Code:72944-3522
Practice Address - Country:US
Practice Address - Phone:479-269-5782
Practice Address - Fax:479-259-9091
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health