Provider Demographics
NPI:1710014873
Name:BAKER, EARL H (PHD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:H
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5628
Mailing Address - Country:US
Mailing Address - Phone:318-323-8700
Mailing Address - Fax:318-323-8757
Practice Address - Street 1:1502 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5628
Practice Address - Country:US
Practice Address - Phone:318-323-8700
Practice Address - Fax:318-323-8757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP577103T00000X
LAMP.000577103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33207OtherCLASS 23 DHH
LA33207OtherCLASS 23 DHH