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Individual
KELLY GOSSARD BAKER
Active
Individual
KELLY GOSSARD BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
000882
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02994838
GROUP MEDICAID
NY
01
—
1235184235
GROUP NPI
—
01
—
BA1047
GROUP MEDICARE
NY
Enumeration date
08/16/2012
Last updated
09/16/2020
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