Provider Demographics
NPI:1962592253
Name:BAUER, THERESA MARIE (LPC, CAC III)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32849 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:MANZANOLA
Mailing Address - State:CO
Mailing Address - Zip Code:81058-9711
Mailing Address - Country:US
Mailing Address - Phone:719-980-0133
Mailing Address - Fax:719-462-5716
Practice Address - Street 1:302 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1329
Practice Address - Country:US
Practice Address - Phone:719-384-8503
Practice Address - Fax:719-384-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3846101YA0400X
CO1562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health