Provider Demographics
NPI:1881737674
Name:BAIN, GENE C (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:C
Last Name:BAIN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 MOUNTAIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1509
Mailing Address - Country:US
Mailing Address - Phone:713-256-1127
Mailing Address - Fax:281-261-0334
Practice Address - Street 1:10333 NORTHWEST FWY
Practice Address - Street 2:505
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8235
Practice Address - Country:US
Practice Address - Phone:713-256-1127
Practice Address - Fax:281-261-0334
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9950101YA0400X
TX18797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153738301Medicaid
TX163476801Medicaid
TX153738302Medicaid