Provider Demographics
NPI:1689107468
Name:BAIN, JULIA (LPCC,NCC,CEAP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:LPCC,NCC,CEAP
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 28628
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8628
Mailing Address - Country:US
Mailing Address - Phone:505-363-3293
Mailing Address - Fax:
Practice Address - Street 1:2916 GOVERNOR MABRY CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6438
Practice Address - Country:US
Practice Address - Phone:505-310-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator