Healthcare Provider Details

I. General information

NPI: 1386799278
Provider Name (Legal Business Name): MARY FRANCES BACA MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 MOUNTAIN ROAD PL NE
ALBUQUERQUE NM
87110-7808
US

IV. Provider business mailing address

PO BOX 6601
ALBUQUERQUE NM
87197-6601
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-7397
  • Fax: 505-433-4565
Mailing address:
  • Phone: 505-315-7397
  • Fax: 505-433-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0983
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: