Provider Demographics
NPI:1265027023
Name:BAKER, LEIGH A (PHD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:A
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 1:3178 SIXMA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-3645
Mailing Address - Country:US
Mailing Address - Phone:386-216-9203
Mailing Address - Fax:
Practice Address - Street 1:3178 SIXMA RD
Practice Address - Street 2:
Practice Address - City:LAKE HELEN
Practice Address - State:FL
Practice Address - Zip Code:32744-3645
Practice Address - Country:US
Practice Address - Phone:386-216-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX37040103TC1900X
FLPY9593103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling