Provider Demographics
NPI:1457088668
Name:BAKER, PAMELA MICHELLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MICHELLE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:24412 POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-5502
Mailing Address - Country:US
Mailing Address - Phone:616-558-8207
Mailing Address - Fax:
Practice Address - Street 1:24412 POWERLINE RD
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-5502
Practice Address - Country:US
Practice Address - Phone:616-558-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health