Healthcare Provider Details

I. General information

NPI: 1962589507
Provider Name (Legal Business Name): MARSHA T GABRIEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 COOPER ST
FORT WORTH TX
76104-2711
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-7450
  • Fax: 682-885-3308
Mailing address:
  • Phone: 682-885-4871
  • Fax: 682-885-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number24410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: