Provider Demographics
NPI:1669961389
Name:BACCUS, DON EUGENE (LPC)
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:EUGENE
Last Name:BACCUS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1004 CLOVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4106
Mailing Address - Country:US
Mailing Address - Phone:214-875-0883
Mailing Address - Fax:972-224-7001
Practice Address - Street 1:3603 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4535
Practice Address - Country:US
Practice Address - Phone:214-875-0883
Practice Address - Fax:972-224-7001
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional