Provider Demographics
NPI:1184163255
Name:BAKSIS, CARYN (LMHCA)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:BAKSIS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S LONG RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-7752
Mailing Address - Country:US
Mailing Address - Phone:509-795-2757
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7553
Practice Address - Country:US
Practice Address - Phone:509-795-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60707494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health