MEDICARE: HEIDI MCBAIN

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	106H00000X	Marriage & Family Therapist	4978	TX
2	101YP2500X	Professional Counselor	18768	TX

General Provider Information

NPI Number	:	1376059782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MCBAIN

Provider Business Mailing Address
First Line	:	2201 LONG PRAIRIE RD STE 107629
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	214-206-6918
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LONG PRAIRIE RD STE 107629
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	214-206-6918
Fax Number	:

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

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	03/29/2018

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Directions to “ HEIDI MCBAIN ” Practice Location

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