Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 70266 | TX |
NPI | 1003292400 |
---|---|
Provider Name | Julie Baines |
First Address | Rowlett, TX 75030-0299 |
Second Address | Rowlett, TX 75088-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2015 |
Last Update Date | 07/08/2015 |