Provider Demographics
NPI:1871684845
Name:MASSEY, GAIL TUCKER (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:TUCKER
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:MS
Other - First Name:GAIL
Other - Middle Name:TUCKER
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:7517 PEABODY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729
Mailing Address - Country:US
Mailing Address - Phone:512-586-1608
Mailing Address - Fax:512-257-8015
Practice Address - Street 1:8500 N MOPAC
Practice Address - Street 2:#818
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-586-1608
Practice Address - Fax:512-257-8015
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
6095LCOtherBCBS NUMBER