Provider Demographics
NPI:1740590256
Name:GAMA, JORGE MARTIN (LPC-INTERN)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:MARTIN
Last Name:GAMA
Suffix:
Gender:M
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PEPPERMILL CIR APT 61
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2677
Mailing Address - Country:US
Mailing Address - Phone:817-846-9112
Mailing Address - Fax:817-624-1213
Practice Address - Street 1:920 ROBERTS CUT OFF RD STE A
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2862
Practice Address - Country:US
Practice Address - Phone:817-624-1222
Practice Address - Fax:817-624-1213
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional