Provider Demographics
NPI:1851594881
Name:JURGENS, GAY E (MSSW)
Entity Type:Individual
Prefix:
First Name:GAY
Middle Name:E
Last Name:JURGENS
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 NORTHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2733
Mailing Address - Country:US
Mailing Address - Phone:214-352-8262
Mailing Address - Fax:
Practice Address - Street 1:3850 NORTHAVEN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2733
Practice Address - Country:US
Practice Address - Phone:214-352-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S56EOtherBCBS
TX00S56EOtherBCBS