Provider Demographics
NPI:1023588480
Name:JORGE M. GAMA LPC PLLC
Entity type:Organization
Organization Name:JORGE M. GAMA LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-730-6363
Mailing Address - Street 1:618 S PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5624 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1161
Practice Address - Country:US
Practice Address - Phone:682-730-6363
Practice Address - Fax:817-483-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty