Provider Demographics
NPI:1740744028
Name:GIFFORD, PATRICE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 PINEY WOOD RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2300
Mailing Address - Country:US
Mailing Address - Phone:334-477-8076
Mailing Address - Fax:
Practice Address - Street 1:116 GALLERY CIR STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3341
Practice Address - Country:US
Practice Address - Phone:210-802-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health