Healthcare Provider Details

I. General information

NPI: 1376640268
Provider Name (Legal Business Name): GAYLIN LEA NORRIS LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7744 BROADWAY ST SUITE 105
SAN ANTONIO TX
78209-3225
US

IV. Provider business mailing address

7744 BROADWAY ST SUITE 105
SAN ANTONIO TX
78209-3225
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-8781
  • Fax: 210-822-7542
Mailing address:
  • Phone: 210-828-8781
  • Fax: 210-822-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: