Individual
KEITH LEVEQ BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
5740 GETWELL RD STE D, SOUTHAVEN, MS 38672-6346
(601) 790-0583
Mailing address
22015 HALLIBURTON CV, OXFORD, MS 38655-7357
(225) 505-9630
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
P-1069
MS
Other
Enumeration date
02/27/2024
Last updated
02/27/2024
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