Provider Demographics
NPI:1902325764
Name:BAKER, ELISSA ELAINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:ELAINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELLISA
Other - Middle Name:ELAINE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:945 LOGAN CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3100
Mailing Address - Country:US
Mailing Address - Phone:970-371-8911
Mailing Address - Fax:
Practice Address - Street 1:320 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2716
Practice Address - Country:US
Practice Address - Phone:970-371-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0005535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health