Provider Demographics
NPI:1942282785
Name:BAINE, STEPHEN TRUMAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:TRUMAN
Last Name:BAINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1560 W BAY AREA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2667
Mailing Address - Country:US
Mailing Address - Phone:281-461-8888
Mailing Address - Fax:281-461-1193
Practice Address - Street 1:1560 W BAY AREA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2667
Practice Address - Country:US
Practice Address - Phone:281-461-8888
Practice Address - Fax:281-461-1193
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS174981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0425878-02Medicaid
TX0425878-02Medicaid