Provider Demographics
NPI:1861188161
Name:BAKER, PATSY TINA (LCADC)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:TINA
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:TINA
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:609 HAMMOND PLZ
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4971
Mailing Address - Country:US
Mailing Address - Phone:270-887-5691
Mailing Address - Fax:270-890-0130
Practice Address - Street 1:609 HAMMOND PLZ
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4971
Practice Address - Country:US
Practice Address - Phone:270-887-5691
Practice Address - Fax:270-890-0130
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)