Provider Demographics
NPI:1770864589
Name:BREHM, GWENDOLYN LEE (MED, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LEE
Last Name:BREHM
Suffix:
Gender:F
Credentials:MED, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 EL CAMINO REAL
Mailing Address - Street 2:SUITE 107D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2715
Mailing Address - Country:US
Mailing Address - Phone:832-741-0266
Mailing Address - Fax:281-486-8575
Practice Address - Street 1:17300 EL CAMINO REAL
Practice Address - Street 2:SUITE 107D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2715
Practice Address - Country:US
Practice Address - Phone:832-741-0266
Practice Address - Fax:281-486-8575
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8983101YM0800X
TX3117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health