Provider Demographics
NPI:1831630805
Name:BAKER, KEVIN LONN (MA, LPC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LONN
Last Name:BAKER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6470
Mailing Address - Country:US
Mailing Address - Phone:806-786-0250
Mailing Address - Fax:
Practice Address - Street 1:5120 29TH DR
Practice Address - Street 2:SUITE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2612
Practice Address - Country:US
Practice Address - Phone:806-786-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional