Provider Demographics
NPI:1255053476
Name:BAECHT, LEA ANN PRESTON (PHD)
Entity type:Individual
Prefix:
First Name:LEA ANN
Middle Name:PRESTON
Last Name:BAECHT
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 1:5275 WHITETAIL RDG
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MO
Mailing Address - Zip Code:65619-4501
Mailing Address - Country:US
Mailing Address - Phone:417-496-6507
Mailing Address - Fax:
Practice Address - Street 1:5275 WHITETAIL RDG
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MO
Practice Address - Zip Code:65619-4501
Practice Address - Country:US
Practice Address - Phone:417-496-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036917103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic