Provider Demographics
NPI:1396400123
Name:ARIAS, GABRIELLE LAUREN
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LAUREN
Last Name:ARIAS
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 1:609 CLAYTON LN APT 255
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-0610
Mailing Address - Country:US
Mailing Address - Phone:305-804-1193
Mailing Address - Fax:
Practice Address - Street 1:609 CLAYTON LN APT 255
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-0610
Practice Address - Country:US
Practice Address - Phone:305-804-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA757
MA777
MA12696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health