Provider Demographics
NPI:1912456732
Name:BAHA, JAMIE (MA, LAC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:BAHA
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HUGHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 WEST PONDEROSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941
Mailing Address - Country:US
Mailing Address - Phone:928-338-4858
Mailing Address - Fax:928-338-4100
Practice Address - Street 1:302 WEST PONDEROSA STREET
Practice Address - Street 2:
Practice Address - City:WHITE RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional