Provider Demographics
NPI:1598194672
Name:BACA-SPRY, ALEXIS A (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:BACA-SPRY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:16659 6250 RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-7822
Practice Address - Country:US
Practice Address - Phone:970-596-2493
Practice Address - Fax:970-249-1576
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16207101YP2500X
COLPC.00015748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional