Provider Demographics
NPI:1932517554
Name:BAINUM, AMBER RUTH
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RUTH
Last Name:BAINUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RUTH
Other - Last Name:EWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1391
Mailing Address - Country:US
Mailing Address - Phone:325-649-4357
Mailing Address - Fax:
Practice Address - Street 1:205 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-2919
Practice Address - Country:US
Practice Address - Phone:325-649-4357
Practice Address - Fax:325-646-0919
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional