Provider Demographics
NPI:1710210638
Name:BAKER, JIMIA L (LPC)
Entity type:Individual
Prefix:MS
First Name:JIMIA
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 COUNTY ROAD 94
Mailing Address - Street 2:#21303
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2958
Mailing Address - Country:US
Mailing Address - Phone:832-443-0784
Mailing Address - Fax:
Practice Address - Street 1:3800 COUNTY ROAD 94
Practice Address - Street 2:#21303
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2958
Practice Address - Country:US
Practice Address - Phone:832-443-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional