Provider Demographics
NPI:1265704191
Name:GAINES, LAURIE (MED, MA, LPC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MED, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 W PLANO PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5629
Mailing Address - Country:US
Mailing Address - Phone:972-612-5615
Mailing Address - Fax:972-468-9428
Practice Address - Street 1:4011 W PLANO PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5629
Practice Address - Country:US
Practice Address - Phone:972-612-5615
Practice Address - Fax:972-468-9428
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68693101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor