Provider Demographics
NPI:1598876062
Name:BALDWIN, LAURIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S
Mailing Address - Street 2:SUITE 390
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2900
Mailing Address - Country:US
Mailing Address - Phone:713-349-0504
Mailing Address - Fax:713-661-0621
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:SUITE 390
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-349-0504
Practice Address - Fax:713-661-0621
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1161192-02Medicaid
TX319392OtherAPS/IRG
TX254583OtherVALUE OPTIONS
TX319392OtherAPS/IRG
TX00U18FMedicare ID - Type Unspecified