Provider Demographics
NPI:1922118876
Name:BAKES, ALAN S (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:BAKES
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 1:1208 PEGGY ANN DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-3237
Mailing Address - Country:US
Mailing Address - Phone:270-809-5313
Mailing Address - Fax:
Practice Address - Street 1:602 S 16TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2284
Practice Address - Country:US
Practice Address - Phone:270-753-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional