Provider Demographics
NPI:1104321934
Name:BACCA-HAUPT, OLIVIA (LPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BACCA-HAUPT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ENCHANTED PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5497
Mailing Address - Country:US
Mailing Address - Phone:314-408-3224
Mailing Address - Fax:
Practice Address - Street 1:128 ENCHANTED PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5497
Practice Address - Country:US
Practice Address - Phone:314-408-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019043813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional