Individual
MR. CODY EVAN BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
TCADC
Contact information
Practice address
807 PEBBLEBROOK DR, LEBANON, KY 40033-1848
(502) 260-2806
Mailing address
807 PEBBLEBROOK DR, LEBANON, KY 40033-1848
(502) 260-2806
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
278074
KY
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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