Provider Demographics
NPI:1174799225
Name:MICHAEL P BAKER DBA ASSOCIATES FOR PSYCHOLOIGCAL & THERAPY SERVICES
Entity type:Organization
Organization Name:MICHAEL P BAKER DBA ASSOCIATES FOR PSYCHOLOIGCAL & THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:712-252-1473
Mailing Address - Street 1:1551 INDIAN HILLS DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1859
Mailing Address - Country:US
Mailing Address - Phone:712-252-1473
Mailing Address - Fax:712-252-5672
Practice Address - Street 1:1551 INDIAN HILLS DR
Practice Address - Street 2:SUITE 221
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1859
Practice Address - Country:US
Practice Address - Phone:712-252-1473
Practice Address - Fax:712-252-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00199101YM0800X
IA01389104100000X
IA046981041C0700X
IA453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0037143Medicaid
IA0037143Medicaid