Provider Demographics
NPI:1740468925
Name:BAKER, MITCHELL (LCPC)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2110
Mailing Address - Country:US
Mailing Address - Phone:847-644-3135
Mailing Address - Fax:
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4830
Practice Address - Country:US
Practice Address - Phone:847-644-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional