Provider Demographics
NPI:1235390014
Name:GREMILLION, PATRICK TROY (MA, LMFT, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TROY
Last Name:GREMILLION
Suffix:
Gender:M
Credentials:MA, LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 HILSHIRE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-6040
Mailing Address - Country:US
Mailing Address - Phone:713-492-5420
Mailing Address - Fax:832-582-6071
Practice Address - Street 1:8831 LONG POINT RD STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3010
Practice Address - Country:US
Practice Address - Phone:713-492-5420
Practice Address - Fax:832-582-6071
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63922101Y00000X, 101YM0800X, 101YP2500X
TX201427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2064818-01Medicaid