Provider Demographics
NPI:1851686737
Name:BAACK, QUENTIN RYAN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:RYAN
Last Name:BAACK
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8451
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-8451
Mailing Address - Country:US
Mailing Address - Phone:254-235-6542
Mailing Address - Fax:
Practice Address - Street 1:3708 W WACO DR STE 5
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5353
Practice Address - Country:US
Practice Address - Phone:254-235-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional