Provider Demographics
NPI:1477439735
Name:BAKER, NICOLE RENE (LSSP)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 MUSTANG TRL
Mailing Address - Street 2:
Mailing Address - City:KOUNTZE
Mailing Address - State:TX
Mailing Address - Zip Code:77625-8374
Mailing Address - Country:US
Mailing Address - Phone:409-454-0366
Mailing Address - Fax:
Practice Address - Street 1:121 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7368
Practice Address - Country:US
Practice Address - Phone:409-454-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72647103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool