Provider Demographics
NPI:1003708348
Name:BAIN, MICHAELA (MS, LPC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11027 OLD MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7655
Mailing Address - Country:US
Mailing Address - Phone:214-212-7947
Mailing Address - Fax:214-212-7947
Practice Address - Street 1:225 W ELLISON ST STE 113
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4705
Practice Address - Country:US
Practice Address - Phone:817-862-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional