Provider Demographics
NPI:1093863706
Name:GHELLER, GINA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:GHELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5909 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BELLAIR
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2417
Mailing Address - Country:US
Mailing Address - Phone:281-813-8330
Mailing Address - Fax:713-463-7181
Practice Address - Street 1:5909 WEST LOOP S
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2402
Practice Address - Country:US
Practice Address - Phone:281-813-8330
Practice Address - Fax:713-463-7181
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103756601Medicaid
TX103756601Medicaid