Provider Demographics
NPI:1770805392
Name:BAKER CARMICHAEL COUNSELING CENTER
Entity type:Organization
Organization Name:BAKER CARMICHAEL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOUTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/MED
Authorized Official - Phone:817-573-6922
Mailing Address - Street 1:900 WHITEHEAD DR
Mailing Address - Street 2:P O BOX 758
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2505
Mailing Address - Country:US
Mailing Address - Phone:817-573-6922
Mailing Address - Fax:817-579-6611
Practice Address - Street 1:900 WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2505
Practice Address - Country:US
Practice Address - Phone:817-573-6922
Practice Address - Fax:817-579-6611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CONCEPTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-23
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027764201Medicaid