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Individual

GARY LEE BAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LISW

Contact information

Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0701003834
VA
1041C0700X
Clinical Social Worker
Primary
I.2002236-SUPV
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0432444
OH
Enumeration date
09/10/2018
Last updated
10/15/2021
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