MEDICARE: LAURIE GAINES M.ED, MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	68693	TX

General Provider Information

NPI Number	:	1265704191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE GAINES M.ED, MA, LPC

Provider Business Mailing Address
First Line	:	4011 W PLANO PKWY
Second Line	:	SUITE 104
City	:	PLANO
State	:	TX
Zip	:	75093-5629
Country	:	US
Telephone Number	:	972-612-5615
Fax Number	:	972-468-9428

Provider Business Practice Location Address
First Line	:	4011 W PLANO PKWY
Second Line	:	SUITE 104
City	:	PLANO
State	:	TX
Zip	:	75093-5629
Country	:	US
Telephone Number	:	972-612-5615
Fax Number	:	972-468-9428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	07/15/2014

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