MEDICARE: JUDY GAITHER 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
1	101Y00000X	Counselor	17111	TX
2	101YP2500X	Professional Counselor	17111	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568563971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY GAITHER LPC

Provider Business Mailing Address
First Line	:	1706 ENDERLY PL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4122
Country	:	US
Telephone Number	:	817-614-6041
Fax Number	:	817-207-8088

Provider Business Practice Location Address
First Line	:	1706 ENDERLY PLACE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-614-6041
Fax Number	:	817-207-8088

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/27/2012

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Directions to “ JUDY GAITHER LPC” Practice Location

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