Provider Demographics
NPI:1033488465
Name:BAACK, HEATHER J (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
Last Name:BAACK
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8098 VECTRA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8024
Mailing Address - Country:US
Mailing Address - Phone:719-649-0145
Mailing Address - Fax:
Practice Address - Street 1:3210 E WOODMEN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3588
Practice Address - Country:US
Practice Address - Phone:719-649-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor