Provider Demographics
NPI:1588290985
Name:BAKER, GORDON RAY JR (MA)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:RAY
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8421 WAYZATA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1382
Mailing Address - Country:US
Mailing Address - Phone:952-835-6540
Mailing Address - Fax:952-835-6650
Practice Address - Street 1:8421 WAYZATA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1382
Practice Address - Country:US
Practice Address - Phone:952-835-6540
Practice Address - Fax:952-835-6650
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC04595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health