Healthcare Provider Details

I. General information

NPI: 1275501975
Provider Name (Legal Business Name): GATEWAYS COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 INDIANA AVE SUITE ONE
LUBBOCK TX
79410-2139
US

IV. Provider business mailing address

2232 INDIANA AVE SUITE ONE
LUBBOCK TX
79410-2139
US

V. Phone/Fax

Practice location:
  • Phone: 806-793-6160
  • Fax: 806-799-0825
Mailing address:
  • Phone: 806-793-6160
  • Fax: 806-799-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11526
License Number StateTX

VIII. Authorized Official

Name: MR. BRET CLAUDE HENDRICKS I
Title or Position: PSYCHOTHERAPIST
Credential: ED.D.
Phone: 806-793-6160