Provider Demographics
NPI:1063003564
Name:HAYWARD, GWENDOLYN B
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:B
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14526 OLD KATY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1042
Mailing Address - Country:US
Mailing Address - Phone:832-230-4487
Mailing Address - Fax:
Practice Address - Street 1:14526 OLD KATY RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1042
Practice Address - Country:US
Practice Address - Phone:832-818-0356
Practice Address - Fax:832-672-7162
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8279101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor