Individual
ALEX LEE BACCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1707 COOKS HILL RD, CENTRALIA, WA 98531-9071
(360) 523-8396
Mailing address
1707 COOKS HILL RD, CENTRALIA, WA 98531-9071
(360) 523-8396
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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