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General NPI Number Information
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NPI Number | 1194105122
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Entity Type | Individual
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Provider Name | GWEN L HODRICK LPC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 09/28/2022
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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 | 214-614-4725
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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 | 214-914-6775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12811
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69392
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20753
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License Number State | AZ
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