Provider Demographics
NPI:1811141617
Name:BAKER, JOHN W (LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 E COUNTRYWALK LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8701
Mailing Address - Country:US
Mailing Address - Phone:602-318-8646
Mailing Address - Fax:480-629-5631
Practice Address - Street 1:1930 S ALMA SCHOOL RD
Practice Address - Street 2:#B213
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3064
Practice Address - Country:US
Practice Address - Phone:602-318-8646
Practice Address - Fax:480-629-5631
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional