Provider Demographics
NPI:1972871440
Name:BAKER, GENE ALLEN (PSYD, HSPP)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:ALLEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1694
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:335 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVLLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4480
Practice Address - Country:US
Practice Address - Phone:812-258-0310
Practice Address - Fax:812-258-0409
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001453A106H00000X
KY0219106H00000X
IN20042705A103TC0700X
OHF . 1100008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist