Provider Demographics
NPI:1003292400
Name:BAINES, JULIE (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BAINES
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0299
Mailing Address - Country:US
Mailing Address - Phone:972-996-2242
Mailing Address - Fax:972-996-2245
Practice Address - Street 1:4702 ROWLETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-1703
Practice Address - Country:US
Practice Address - Phone:972-996-2242
Practice Address - Fax:972-996-2245
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional