Individual
ANDREA BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 CHINOOK LN, PUEBLO, CO 81001
(719) 545-2746
(719) 423-1193
Mailing address
1310 CHINOOK LN, PUEBLO, CO 81001-1851
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC.0013938
CO
Other
Enumeration date
10/01/2015
Last updated
08/20/2018
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