Provider Demographics
NPI:1871696294
Name:BAKER, BONNIE B (LMHC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:B
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NW 27TH CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6593
Mailing Address - Country:US
Mailing Address - Phone:352-338-0397
Mailing Address - Fax:352-372-6787
Practice Address - Street 1:5000 NW 27TH CT
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6593
Practice Address - Country:US
Practice Address - Phone:352-338-0397
Practice Address - Fax:352-372-6787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11378963OtherCAQH
FLZ1735OtherBCBS OF FL