Provider Demographics
NPI:1205944725
Name:GALLARDO, HECTOR H (LPC)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:H
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:HECTOR
Other - Middle Name:H
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7395 BLACK MESA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3034
Mailing Address - Country:US
Mailing Address - Phone:915-407-4340
Mailing Address - Fax:
Practice Address - Street 1:7395 BLACK MESA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3034
Practice Address - Country:US
Practice Address - Phone:915-407-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84920LOtherBCBSTX
TX095792003Medicaid
TX095792003Medicaid