Provider Demographics
NPI:1568563971
Name:GAITHER, JUDY (LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:GAITHER
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 1:1706 ENDERLY PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4122
Mailing Address - Country:US
Mailing Address - Phone:817-614-6041
Mailing Address - Fax:817-207-8088
Practice Address - Street 1:1706 ENDERLY PLACE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-614-6041
Practice Address - Fax:817-207-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17111101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157081402Medicaid