Provider Demographics
NPI:1013512706
Name:GAMBOA, ALEXANDRA (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13833 PADDLEWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5242
Mailing Address - Country:US
Mailing Address - Phone:361-585-3646
Mailing Address - Fax:
Practice Address - Street 1:3308 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6549
Practice Address - Country:US
Practice Address - Phone:210-239-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional