Provider Demographics
NPI:1427236371
Name:BAKER, SANDRA JO (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JO
Last Name:BAKER
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:JO
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:111 PORT O CALL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-9382
Mailing Address - Country:US
Mailing Address - Phone:806-622-3672
Mailing Address - Fax:806-354-9596
Practice Address - Street 1:111 PORT O CALL
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-9382
Practice Address - Country:US
Practice Address - Phone:806-622-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional