Individual
MR. JESSE LEE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
4210 MEADOWLARK LN SE, RIO RANCHO, NM 87124-1021
(505) 425-6788
Mailing address
PO BOX 158, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 426-3492
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CTB-2024-0200
NM
Other
Enumeration date
08/26/2019
Last updated
05/05/2025
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