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General NPI Number Information
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NPI Number | 1376113035
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Entity Type | Organization
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Legal Business Name | GLADSTONE TELEHEALTH PLLC
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 4775 W PANTHER CREEK DR STE C300
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City | THE WOODLANDS
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State | TX
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Zip | 77381-3592
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Country | US
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Telephone | 346-331-3372
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Fax | 866-572-2503
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Provider Business Mailing Address
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Address Line | 4775 W PANTHER CREEK DR STE C300
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City | THE WOODLANDS
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State | TX
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Zip | 77381-3592
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Country | US
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Telephone | 346-331-3372
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Fax | 281-789-3405
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Authorized Official
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Title or Position | MANAGING PRINCIPAL
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Name | DR. ANDREW S BUTLER
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Credential | MD
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Telephone | 346-331-3372
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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