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Individual

DR. RICHARD THOMAS BAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-1130
Mailing address
4820 CLEARVIEW AVE, POCATELLO, ID 83204-5026
(208) 241-4955

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-202235
ID

Other

Enumeration date
09/11/2013
Last updated
09/11/2013
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