Provider Demographics
NPI:1245374784
Name:BAKER, KELLEY ALLISON (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:ALLISON
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W LEGEND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5004
Mailing Address - Country:US
Mailing Address - Phone:512-310-5848
Mailing Address - Fax:512-310-9705
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD
Practice Address - Street 2:STE 89
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3990
Practice Address - Country:US
Practice Address - Phone:512-310-5848
Practice Address - Fax:512-310-9705
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist