MEDICARE: GESSLYN ENGELHARD 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	101YM0800X	Mental Health Counselor	12112	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3970LC	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1639185663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GESSLYN ENGELHARD LPC

Provider Business Mailing Address
First Line	:	18100 UPPER BAY RD
Second Line	:	SUITE 116
City	:	HOUSTON
State	:	TX
Zip	:	77058-3548
Country	:	US
Telephone Number	:	281-308-1520
Fax Number	:	281-240-6481

Provider Business Practice Location Address
First Line	:	18100 UPPER BAY RD
Second Line	:	SUITE 116
City	:	HOUSTON
State	:	TX
Zip	:	77058-3548
Country	:	US
Telephone Number	:	281-308-1520
Fax Number	:	281-240-6481

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/09/2007

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