Healthcare Provider Details

I. General information

NPI: 1043867435
Provider Name (Legal Business Name): JOHANA BACA FLORES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EL PASEO RD STE B
LAS CRUCES NM
88001-6019
US

IV. Provider business mailing address

2540 EL PASEO RD STE B
LAS CRUCES NM
88001-6019
US

V. Phone/Fax

Practice location:
  • Phone: 575-243-5846
  • Fax: 575-652-4381
Mailing address:
  • Phone: 575-243-5846
  • Fax: 575-652-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: