Provider Demographics
NPI:1124166749
Name:BAKER, JULIE CLEVERDON (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:CLEVERDON
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10406
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-3406
Mailing Address - Country:US
Mailing Address - Phone:406-314-0475
Mailing Address - Fax:406-257-9721
Practice Address - Street 1:17 2ND ST E
Practice Address - Street 2:SUITE 206
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6107
Practice Address - Country:US
Practice Address - Phone:406-314-0475
Practice Address - Fax:406-257-9721
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256958Medicaid