Provider Demographics
NPI:1740796135
Name:GULLEDGE, DEBRA M (MA LPC DCC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:M
Last Name:GULLEDGE
Suffix:
Gender:F
Credentials:MA LPC DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 LINDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223
Mailing Address - Country:US
Mailing Address - Phone:214-803-9883
Mailing Address - Fax:214-321-5496
Practice Address - Street 1:301 W MALLOY BRIDGE RD.
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159
Practice Address - Country:US
Practice Address - Phone:214-805-4543
Practice Address - Fax:214-321-5496
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73095LPC101YP2500X
TX2433DCC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional