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General NPI Number Information
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NPI Number | 1518604115
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Entity Type | Individual
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Provider Name | MARIA GABRIELA SPICER LPC-A
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 1130 N KIMBALL AVE
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5567
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Country | US
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Telephone | 940-331-0446
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Fax |
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Provider Business Mailing Address
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Address Line | 2864 MILSONS POINT DR
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City | TROPHY CLUB
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State | TX
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Zip | 76262-1570
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Country | US
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Telephone | 817-714-4103
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88545
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License Number State | TX
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