Provider Demographics
NPI:1457453219
Name:BAINS, ELSA JO (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:JO
Last Name:BAINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3211
Mailing Address - Country:US
Mailing Address - Phone:325-672-7755
Mailing Address - Fax:325-672-2165
Practice Address - Street 1:1025 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-3211
Practice Address - Country:US
Practice Address - Phone:325-672-7755
Practice Address - Fax:325-672-2165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health