Active NPI
Mindy Block Bacchus, LPC
- Professional Counselor
- Georgetown, TX
National Provider Identifier
1124313432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 63473
- Practice address
- 404 W 9TH St
Suite 104
Georgetown, TX 78626-5543 - Phone
- (512) 864-5911
- NPI assigned
- Jun 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 63473 | TX | Primary |
Addresses
Primary practice location
404 W 9TH St
Suite 104
Georgetown, TX 78626-5543
Mailing address
404 W 9TH St
Suite 104
Georgetown, TX 78626-5543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63473 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308009600000",
"number": "1124313432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 W 9TH ST",
"address_2": "SUITE 104",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786265543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 W 9TH ST",
"address_2": "SUITE 104",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786265543",
"telephone_number": "512-864-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACCHUS",
"first_name": "MINDY",
"middle_name": "BLOCK",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-14",
"last_updated": "2011-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "63473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.