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NPI Code Detail

MEDICARE: MRS. ELSIE ANN GAUDREAULT LPC

MEDICARE: MRS. ELSIE ANN GAUDREAULT LPC
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
1101YP2500XProfessional Counselor18135TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13905 723OTHERTXHOME ADDRESS NUMBERS

General Provider Information

NPI Number : 1548355928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELSIE ANN GAUDREAULT LPC
Provider Business Mailing Address
First Line : 6055 MONTE VISTA LN
Second Line : 932
City : FORT WORTH
State : TX
Zip : 76132-5419
Country : US
Telephone Number : 817-240-7883
Fax Number : 817-922-1076
Provider Business Practice Location Address
First Line : 3905 GABLE LN
Second Line : 723
City : FORT WORTH
State : TX
Zip : 76155-2829
Country : US
Telephone Number : 817-240-7883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 09/28/2009

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