Healthcare Provider Details

I. General information

NPI: 1174981658
Provider Name (Legal Business Name): DRIZANNE GUDA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR SUITE 261
HOUSTON TX
77024-2420
US

IV. Provider business mailing address

9807 HALLIFORD DR
HOUSTON TX
77031-2604
US

V. Phone/Fax

Practice location:
  • Phone: 713-338-5753
  • Fax:
Mailing address:
  • Phone: 832-226-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: