Provider Demographics
NPI:1518408350
Name:BACKER, MAURICE PATRICK (LCAC)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:PATRICK
Last Name:BACKER
Suffix:
Gender:M
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 NW 4TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1350
Mailing Address - Country:US
Mailing Address - Phone:812-422-6812
Mailing Address - Fax:812-228-1113
Practice Address - Street 1:201 NW 4TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1350
Practice Address - Country:US
Practice Address - Phone:812-422-6812
Practice Address - Fax:812-228-1113
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000738A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)