Healthcare Provider Details

I. General information

NPI: 1881737674
Provider Name (Legal Business Name): GENE C BAIN LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 NORTHWEST FWY 505
HOUSTON TX
77092-8235
US

IV. Provider business mailing address

1243 MOUNTAIN LAKE DR
MISSOURI CITY TX
77459-1509
US

V. Phone/Fax

Practice location:
  • Phone: 713-256-1127
  • Fax: 281-261-0334
Mailing address:
  • Phone: 713-256-1127
  • Fax: 281-261-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9950
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: