Individual
KRISTOPHER W. R BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1510 S VINE AVE, TYLER, TX 75701-2826
(903) 526-4055
Mailing address
220 PRIVATE ROAD 8179, EDOM, TX 75754-5268
(903) 519-6858
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12645
TX
Other
Enumeration date
09/13/2022
Last updated
09/13/2022
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