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Individual

LESLIE ANN BACA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
707 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2360
(505) 345-8471
Mailing address
1709 MOON ST. NE, ALBUQUERQUE, NM 87112
(505) 271-0329

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
103K00000X
Behavior Analyst

Other

Enumeration date
04/10/2019
Last updated
05/08/2020
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