Individual
KELLY A. BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
872 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5927
(505) 867-2383
(505) 867-7293
Mailing address
1169 MAPLE ST, BERNALILLO, NM 87004-6513
(505) 867-2383
(505) 867-7293
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT - 91541
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39908879
—
NM
Enumeration date
08/05/2006
Last updated
05/02/2008
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