Provider Demographics
NPI:1265074348
Name:BAKER, MELINDA LEEANN (LCSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEEANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MYNDI
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:710 IVY PL
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8341
Mailing Address - Country:US
Mailing Address - Phone:970-712-1492
Mailing Address - Fax:
Practice Address - Street 1:1000 N 9TH ST STE 24
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3161
Practice Address - Country:US
Practice Address - Phone:970-712-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922716101YM0800X
COCSW0992882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health