Provider Demographics
NPI:1285334011
Name:BAJAJ, MARY JANE (MA, LPC, LSOTP, BHSV)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:MA, LPC, LSOTP, BHSV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 S ABE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-7266
Mailing Address - Country:US
Mailing Address - Phone:325-718-4956
Mailing Address - Fax:
Practice Address - Street 1:1207 S ABE ST STE C
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-7266
Practice Address - Country:US
Practice Address - Phone:325-718-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional