Provider Demographics
NPI:1770117590
Name:BAKER, CAMILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
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 1:6824 WAYNE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1649
Mailing Address - Country:US
Mailing Address - Phone:806-243-1680
Mailing Address - Fax:806-451-5166
Practice Address - Street 1:6824 WAYNE AVE STE 1
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1649
Practice Address - Country:US
Practice Address - Phone:806-243-1680
Practice Address - Fax:806-451-5166
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38364103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling