MEDICARE: DR. LAURIE BALDWIN PH.D.

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	103TC0700X	Clinical Psychologist	2-5249	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	319392	OTHER	TX	APS/IRG
3	254583	OTHER	TX	VALUE OPTIONS

General Provider Information

NPI Number	:	1598876062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE BALDWIN PH.D.

Provider Business Mailing Address
First Line	:	6300 WEST LOOP S
Second Line	:	SUITE 390
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2900
Country	:	US
Telephone Number	:	713-349-0504
Fax Number	:	713-661-0621

Provider Business Practice Location Address
First Line	:	6300 WEST LOOP S
Second Line	:	SUITE 390
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2900
Country	:	US
Telephone Number	:	713-349-0504
Fax Number	:	713-661-0621

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/23/2010

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