Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1114937471 |
---|---|
Provider Name | Mr. Samuel Thomas Baker |
First Address | Lebanon, TN 37087-2677 |
Second Address | Nashville, TN 37212-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |