Individual
BRAD BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2235 E 25TH ST STE 290, IDAHO FALLS, ID 83404-7595
(208) 552-0490
(208) 552-2518
Mailing address
PO BOX 3480, IDAHO FALLS, ID 83403-3480
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-3192
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806472900
—
ID
Enumeration date
12/12/2006
Last updated
07/09/2007
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