Provider Demographics
NPI:1033449269
Name:BAIN, JOEL (LMFT, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BAIN
Suffix:
Gender:M
Credentials:LMFT, LPC-MHSP
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 18272
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-2272
Mailing Address - Country:US
Mailing Address - Phone:865-235-9322
Mailing Address - Fax:865-342-7873
Practice Address - Street 1:4032 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5103
Practice Address - Country:US
Practice Address - Phone:865-235-9322
Practice Address - Fax:865-342-7873
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000000770106H00000X
TNLPC0000002666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional