Provider Demographics
NPI:1629230537
Name:BACA, ROWENA NICOLE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ROWENA
Middle Name:NICOLE
Last Name:BACA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2225
Mailing Address - Country:US
Mailing Address - Phone:720-471-8566
Mailing Address - Fax:
Practice Address - Street 1:700 FRONT ST STE 201A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1805
Practice Address - Country:US
Practice Address - Phone:720-471-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional