Provider Demographics
NPI:1851498778
Name:BACKS, NORMA JO (EDD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:JO
Last Name:BACKS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SOUTH ALABAMA
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102
Mailing Address - Country:US
Mailing Address - Phone:806-354-8300
Mailing Address - Fax:806-354-9962
Practice Address - Street 1:#22 CARE CIRCLE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-354-8300
Practice Address - Fax:806-679-3729
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1615101YA0400X
TX8696101YP2500X
TX2270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026316201Medicaid
2870LCOtherBCBS