Provider Demographics
NPI:1821506627
Name:GATEWAY ONLINE COUNSELING PLLC
Entity Type:Organization
Organization Name:GATEWAY ONLINE COUNSELING PLLC
Other - Org Name:GATEWAY 2 COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:713-899-0614
Mailing Address - Street 1:910 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-6355
Mailing Address - Country:US
Mailing Address - Phone:713-899-0614
Mailing Address - Fax:
Practice Address - Street 1:910 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-6355
Practice Address - Country:US
Practice Address - Phone:713-899-0614
Practice Address - Fax:713-899-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194843425Medicaid