Provider Demographics
NPI:1780150268
Name:BAKER, TIPHANIE MONIQUE (MS)
Entity type:Individual
Prefix:MS
First Name:TIPHANIE
Middle Name:MONIQUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 RAINTREE CT APT E
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-3649
Mailing Address - Country:US
Mailing Address - Phone:205-356-1376
Mailing Address - Fax:
Practice Address - Street 1:2316 RAINTREE CT APT E
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-3649
Practice Address - Country:US
Practice Address - Phone:205-356-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health