Provider Demographics
NPI:1679046171
Name:GANDARA, DAVID OSVALDO (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:OSVALDO
Last Name:GANDARA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 BROOKLAKE ST W
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-1622
Mailing Address - Country:US
Mailing Address - Phone:903-413-0450
Mailing Address - Fax:
Practice Address - Street 1:2207 BROOKLAKE ST W
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-1622
Practice Address - Country:US
Practice Address - Phone:903-413-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical