Basic Information
| Provider Information | |||||||||
| NPI: | 1003292400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAINES | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 299 | ||||||||
| Address2: | |||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750300299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729962242 | ||||||||
| FaxNumber: | 9729962245 | ||||||||
| Practice Location | |||||||||
| Address1: | 4702 ROWLETT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750881703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729962242 | ||||||||
| FaxNumber: | 9729962245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2015 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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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 | 70266 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.