Basic Information
| Provider Information | |||||||||
| NPI: | 1598194672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACA-SPRY | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.A., LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707650818 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 16659 6250 RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814037822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705962493 | ||||||||
| FaxNumber: | 9702491576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2013 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-16207 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPC.00015748 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.