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General NPI Number Information
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NPI Number | 1225456460
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Entity Type | Individual
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Provider Name | GAYLE ANN ALLEN BAA,CPCT,BAT
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Gender | Female
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1802 WILDWOOD ST STE B
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City | VICTORIA
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State | TX
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Zip | 77901-7166
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Country | US
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Telephone | 361-596-3651
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Fax | 361-600-2093
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Provider Business Mailing Address
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Address Line | 1802 WILDWOOD ST STE B
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City | VICTORIA
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State | TX
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Zip | 77901-7166
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Country | US
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Telephone | 361-596-3651
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Fax | 361-600-2093
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 25894411
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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