Provider Demographics
NPI:1225404973
Name:BAKER, TAMARA KATRINA (MA)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KATRINA
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:KATRINA
Other - Last Name:HOCKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 CROOKED LN
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-9213
Mailing Address - Country:US
Mailing Address - Phone:208-278-6027
Mailing Address - Fax:
Practice Address - Street 1:1309 PONDEROSA DR STE 203
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8278
Practice Address - Country:US
Practice Address - Phone:208-278-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF88283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist