Provider Demographics
NPI:1982613501
Name:BAKER, ARTHUR DALE (MS, MDIV, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:DALE
Last Name:BAKER
Suffix:
Gender:M
Credentials:MS, MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SUNRISE AVE
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4679
Mailing Address - Country:US
Mailing Address - Phone:209-598-6852
Mailing Address - Fax:209-492-9458
Practice Address - Street 1:1600 SUNRISE AVE
Practice Address - Street 2:SUITE 7B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4679
Practice Address - Country:US
Practice Address - Phone:209-598-6852
Practice Address - Fax:209-492-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist