Kristopher W. R Baker, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

12645 Issued in TX

Practice address

1510 S Vine Ave
Tyler, TX 75701-2826

Phone

(903) 526-4055

NPI assigned

Sep 13, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbaker@ctc.care

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Methadone Clinic of East Texas LLC

  • Methadone Clinic
  • Tyler, TX
  • NPI 1104144088
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1831811397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 PRIVATE ROAD 8179",
            "city": "EDOM",
            "state": "TX",
            "postal_code": "757545268",
            "telephone_number": "903-519-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S VINE AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012826",
            "telephone_number": "903-526-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "KRISTOPHER",
        "middle_name": "W. R",
        "credential": "LCDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "12645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kbaker@ctc.care",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1510 S Vine Ave",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757012826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Baker O & P Enterprises, Inc.
• Alexa Baker
• Amber Marie Baker, RN
• Christina Kay Baker, FNP-BC
• Debra D Baker
• Mary Suzanne Baker
• Noel Susan Baker, MD
• Grant Baldwin, LPC
• Mary Baldwin, NP
• Corey D Ball, M.D.

• All providers in Tyler, TX
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.