Provider Demographics
NPI:1932372257
Name:BACA, ANTHONY PETER (LPCC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PETER
Last Name:BACA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL ARTS AVE NE
Mailing Address - Street 2:BUILDING #3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2706
Mailing Address - Country:US
Mailing Address - Phone:505-842-5300
Mailing Address - Fax:505-765-1100
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE
Practice Address - Street 2:BUILDING #3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-842-5300
Practice Address - Fax:505-765-1100
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0150761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health