Provider Demographics
NPI:1356460067
Name:BACHUS, LAWRENCE PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PATRICK
Last Name:BACHUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:B-250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:512-656-0131
Mailing Address - Fax:
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:B-250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:512-656-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22838103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent