Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 776 | MT |
NPI | 1003821976 |
---|---|
Provider Name | Mr. Brooks William Baer |
First Address | Liberty Lake, WA 99019-0012 |
Second Address | Missoula, MT 59802-2928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 05/02/2016 |