Provider Demographics
NPI:1578085171
Name:BACA DAVILA, JENNIFER MERRILL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MERRILL
Last Name:BACA DAVILA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MERRILL
Other - Last Name:BACA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JENNIFER BACA, LPC
Mailing Address - Street 1:13740 RESEARCH BLVD STE N8
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1834
Mailing Address - Country:US
Mailing Address - Phone:512-939-7769
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD STE N8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1834
Practice Address - Country:US
Practice Address - Phone:512-939-7769
Practice Address - Fax:512-939-7769
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health