Provider Demographics
NPI:1558578401
Name:CLEVENGER, GAYLYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:GAYLYNN
Middle Name:
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4434
Mailing Address - Country:US
Mailing Address - Phone:512-395-8866
Mailing Address - Fax:
Practice Address - Street 1:451 N MEYER ST
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5441
Practice Address - Country:US
Practice Address - Phone:512-268-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional