Provider Demographics
NPI:1104672120
Name:BACKER COUNSELING LLC
Entity type:Organization
Organization Name:BACKER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-385-7839
Mailing Address - Street 1:4712 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4922
Mailing Address - Country:US
Mailing Address - Phone:786-385-7839
Mailing Address - Fax:
Practice Address - Street 1:1138 EDGEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5369
Practice Address - Country:US
Practice Address - Phone:904-385-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty