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General NPI Number Information
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NPI Number | 1114607850
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Entity Type | Organization
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Legal Business Name | ASK COACH GWEN , LLC
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 660 ACOMA BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-3662
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Country | US
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Telephone | 214-702-6775
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Fax |
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Provider Business Mailing Address
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Address Line | 660 ACOMA BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-3662
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Country | US
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Telephone | 214-702-6775
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Fax |
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Authorized Official
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Title or Position | CEO AND THERAPIST
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Name | GWEN L HODRICK
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Credential | LPC
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Telephone | 214-702-6775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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