Active NPI
Jeannette Verna Baca, ED.D., LPCC
- Professional Counselor
- Albuquerque, NM
National Provider Identifier
1669018479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CCMH0177521
- Practice address
- 6612 Gulton CT NE
Albuquerque, NM 87109-4407 - Phone
- (505) 888-1686
- NPI assigned
- Nov 27, 2019
- Last updated
- Nov 27, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CCMH0177521 | NM | Primary |
Addresses
Primary practice location
6612 Gulton CT NE
Albuquerque, NM 87109-4407
Mailing address
16 Via Sole Dr
Algodones, NM 87001-8078
Phone (505) 573-1439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CCMH0177521 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574812800000",
"number": "1669018479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 VIA SOLE DR",
"city": "ALGODONES",
"state": "NM",
"postal_code": "870018078",
"telephone_number": "505-573-1439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6612 GULTON CT NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094407",
"telephone_number": "505-888-1686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACA",
"first_name": "JEANNETTE",
"middle_name": "VERNA",
"credential": "ED.D., LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-27",
"last_updated": "2019-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "CCMH0177521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.