=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881407641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BIANCA ALYSSA GAYTAN LPC ASSOCIATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 TELEPHONE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77023-1840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-660-1880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2915 WHEELER ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-5388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-865-3673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 94123
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------