Provider Demographics
NPI:1508413881
Name:GATES, JASPER BRYAN (LPC)
Entity Type:Individual
Prefix:
First Name:JASPER
Middle Name:BRYAN
Last Name:GATES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 TELGE RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2289
Mailing Address - Country:US
Mailing Address - Phone:281-989-1053
Mailing Address - Fax:
Practice Address - Street 1:12715 TELGE RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2289
Practice Address - Country:US
Practice Address - Phone:713-466-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74906101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74906OtherLPC