Provider Demographics
NPI:1114607850
Name:ASK COACH GWEN , LLC
Entity Type:Organization
Organization Name:ASK COACH GWEN , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-702-6775
Mailing Address - Street 1:660 ACOMA BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3662
Mailing Address - Country:US
Mailing Address - Phone:214-702-6775
Mailing Address - Fax:
Practice Address - Street 1:660 ACOMA BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-3662
Practice Address - Country:US
Practice Address - Phone:214-702-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty