Provider Demographics
NPI:1891703096
Name:BAKER, JASON TODD (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:TODD
Last Name:BAKER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5751 KROGER DR
Mailing Address - Street 2:STE 237
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5532
Mailing Address - Country:US
Mailing Address - Phone:817-812-2880
Mailing Address - Fax:817-812-3096
Practice Address - Street 1:5751 KROGER DR
Practice Address - Street 2:STE 237
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5532
Practice Address - Country:US
Practice Address - Phone:817-812-2880
Practice Address - Fax:817-812-3096
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health