MEDICARE: GATES COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1457092686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATES COUNSELING PLLC

Provider Business Mailing Address
First Line	:	1104 LAKIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1827
Country	:	US
Telephone Number	:	682-667-4164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 LAKIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1827
Country	:	US
Telephone Number	:	682-667-4164
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LPC
Name	:	REBECCA CHRISTINE GATES
Credential	:	LPC
Telephone Number	:	682-667-4164

Provider Enumeration Date	:	04/03/2022
Last Update Date	:	04/03/2022

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Directions to “GATES COUNSELING PLLC ” Practice Location

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