Provider Demographics
NPI:1407605231
Name:BAKER, DOUGLAS MICHAEL (LLMSW)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:BAKER
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4031
Mailing Address - Country:US
Mailing Address - Phone:906-262-0071
Mailing Address - Fax:989-267-0230
Practice Address - Street 1:1025 W WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4031
Practice Address - Country:US
Practice Address - Phone:906-262-0071
Practice Address - Fax:989-267-0230
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-06-04
Deactivation Date:2024-05-20
Deactivation Code:
Reactivation Date:2024-06-04
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical