Provider Demographics
NPI:1184250300
Name:BAKER, CRAIG (MFT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-2003
Mailing Address - Country:US
Mailing Address - Phone:925-565-6414
Mailing Address - Fax:
Practice Address - Street 1:265 S WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:UT
Practice Address - Zip Code:84653-2003
Practice Address - Country:US
Practice Address - Phone:925-565-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1112908-3904101YM0800X
UT11129018-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health