Basic Information
| Provider Information | |||||||||
| NPI: | 1972871440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | GENE | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | PSY.D, HSPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 S ROGERS ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474032353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123391694 | ||||||||
| FaxNumber: | 8123372438 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVLLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471304480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122580310 | ||||||||
| FaxNumber: | 8122580409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35001453A | IN | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 0219 | KY | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | 20042705A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 106H00000X | F . 1100008 | OH | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.