1760531552 NPI number — MS. RHONDA A GIST LPC

Table of content: MS. RHONDA A GIST LPC (NPI 1760531552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760531552 NPI number — MS. RHONDA A GIST LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIST
Provider First Name:
RHONDA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

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:
1760531552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 COLLIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-693-4688
Provider Business Mailing Address Fax Number:
469-519-9482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 S JUPITER RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-772-8484
Provider Business Practice Location Address Fax Number:
469-519-9482
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  18816 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 18816 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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