Provider Demographics
NPI:1205296241
Name:OTT, GINEVRA (LPC)
Entity type:Individual
Prefix:
First Name:GINEVRA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 COUNTY ROAD 3126
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-4130
Mailing Address - Country:US
Mailing Address - Phone:213-232-1849
Mailing Address - Fax:
Practice Address - Street 1:2612 JORDAN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-3313
Practice Address - Country:US
Practice Address - Phone:903-454-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional