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General NPI Number Information
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NPI Number | 1497264006
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Entity Type | Individual
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Provider Name | GWENDOLYN KAY BAIN LPC-S, LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2125 MARTIN DR STE 100
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City | BEDFORD
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State | TX
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Zip | 76021-5992
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Country | US
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Telephone | 682-704-2601
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 MARTIN DR STE 100
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City | BEDFORD
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State | TX
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Zip | 76021-5992
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Country | US
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Telephone | 682-704-2601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19068
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License Number State | TX
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