Provider Demographics
NPI:1568702421
Name:BAYLOR UNIVERSITY
Entity Type:Organization
Organization Name:BAYLOR UNIVERSITY
Other - Org Name:BAYLOR UNIVERSITY COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, STUDENT LIFE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-710-1314
Mailing Address - Street 1:209 SPEIGHT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1507
Mailing Address - Country:US
Mailing Address - Phone:254-710-2467
Mailing Address - Fax:254-710-2460
Practice Address - Street 1:209 SPEIGHT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1507
Practice Address - Country:US
Practice Address - Phone:254-710-2467
Practice Address - Fax:254-710-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health