Provider Demographics
NPI:1043489198
Name:HIVELY, GARY R (LCDC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:HIVELY
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W HWY 377
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5627
Mailing Address - Country:US
Mailing Address - Phone:817-573-6002
Mailing Address - Fax:817-573-6009
Practice Address - Street 1:2111 W HWY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5627
Practice Address - Country:US
Practice Address - Phone:817-573-6002
Practice Address - Fax:817-573-6009
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)