Healthcare Provider Details

I. General information

NPI: 1972074896
Provider Name (Legal Business Name): GARY HOMINICK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14948 BELCLAIRE AVE
ALEDO TX
76008-1589
US

IV. Provider business mailing address

PO BOX 2603
FORT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 682-231-2239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: