Healthcare Provider Details

I. General information

NPI: 1689107468
Provider Name (Legal Business Name): JULIA BAIN LPCC,NCC,CEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 GOVERNOR MABRY CT
SANTA FE NM
87505-6438
US

IV. Provider business mailing address

PO BOX 28628
SANTA FE NM
87592-8628
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-9069
  • Fax:
Mailing address:
  • Phone: 505-363-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: