Provider Demographics
NPI:1134225386
Name:BALDWIN, BRET M (PHD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 VISTA DE ORO
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4950
Mailing Address - Country:US
Mailing Address - Phone:214-923-8978
Mailing Address - Fax:
Practice Address - Street 1:305 RYAN CT
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4720
Practice Address - Country:US
Practice Address - Phone:972-372-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32036103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152854903Medicaid
TX152854903Medicaid