Provider Demographics
NPI:1316082001
Name:BAER, MARSHA DIANNE (MS, LPC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:DIANNE
Last Name:BAER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LEE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6911
Mailing Address - Country:US
Mailing Address - Phone:479-262-2445
Mailing Address - Fax:
Practice Address - Street 1:108 N 18TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3246
Practice Address - Country:US
Practice Address - Phone:479-709-9779
Practice Address - Fax:479-709-9779
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0904021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional