Provider Demographics
NPI:1992043129
Name:HODGES, GAYLE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ELIZABETH
Last Name:HODGES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 BELLERIVE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7550
Mailing Address - Country:US
Mailing Address - Phone:469-877-8749
Mailing Address - Fax:214-879-8927
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6234
Practice Address - Country:US
Practice Address - Phone:214-879-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical