Provider Demographics
NPI:1063568228
Name:GAINES, STEVEN LEE
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEE
Last Name:GAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E DRANE AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1422
Mailing Address - Country:US
Mailing Address - Phone:903-872-2596
Mailing Address - Fax:903-872-2596
Practice Address - Street 1:410 E DRANE AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-1422
Practice Address - Country:US
Practice Address - Phone:903-872-2596
Practice Address - Fax:903-872-2596
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14127101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor