MEDICARE: PATRICK TROY GREMILLION MA, LMFT, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	63922	TX
2	101YM0800X	Mental Health Counselor	63922	TX
3	101YP2500X	Professional Counselor	63922	TX
4	106H00000X	Marriage & Family Therapist	201427	TX

General Provider Information

NPI Number	:	1235390014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK TROY GREMILLION MA, LMFT, LPC, NCC

Provider Business Mailing Address
First Line	:	2206 HILSHIRE TRAIL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-6040
Country	:	US
Telephone Number	:	713-492-5420
Fax Number	:	832-582-6071

Provider Business Practice Location Address
First Line	:	8831 LONG POINT RD STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3010
Country	:	US
Telephone Number	:	713-492-5420
Fax Number	:	832-582-6071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	11/19/2018

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