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General NPI Number Information
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NPI Number | 1548355928
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Entity Type | Individual
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Provider Name | ELSIE ANN GAUDREAULT LPC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 3905 GABLE LN 723
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City | FORT WORTH
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State | TX
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Zip | 76155-2829
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Country | US
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Telephone | 817-240-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 6055 MONTE VISTA LN 932
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City | FORT WORTH
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State | TX
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Zip | 76132-5419
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Country | US
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Telephone | 817-240-7883
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Fax | 817-922-1076
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18135
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License Number State | TX
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