Individual
MEREDITH BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, LPC
Contact information
Practice address
360 FOG ROAD, ESPANOLA, NM 87532
(210) 862-1037
Mailing address
PO BOX 1045, OHKAY OWINGEH, NM 87566-1045
(210) 593-8552
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
68716
TX
101YM0800X
Mental Health Counselor
Primary
CCMH200151
NM
Other
Enumeration date
11/17/2014
Last updated
11/09/2018
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