1275501975 NPI number — GATEWAYS COUNSELING, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275501975 NPI number — GATEWAYS COUNSELING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAYS COUNSELING, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275501975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2232 INDIANA AVE
Provider Second Line Business Mailing Address:
SUITE ONE
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-793-6160
Provider Business Mailing Address Fax Number:
806-799-0825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2232 INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-6160
Provider Business Practice Location Address Fax Number:
806-799-0825
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
BRET
Authorized Official Middle Name:
CLAUDE
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
806-793-6160

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  11526 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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