Provider Demographics
NPI:1225206337
Name:GAMBLE, KATHY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 ROLLING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2221
Mailing Address - Country:US
Mailing Address - Phone:713-705-0456
Mailing Address - Fax:
Practice Address - Street 1:12910 ROLLING VALLEY DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2221
Practice Address - Country:US
Practice Address - Phone:713-705-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114083Medicare PIN