Provider Demographics
NPI:1205945441
Name:TEBBS GATES, PATRICIA ANN (MA MED LPC LCDC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:TEBBS GATES
Suffix:
Gender:F
Credentials:MA MED LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA ROAD
Mailing Address - Street 2:STE 200C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238
Mailing Address - Country:US
Mailing Address - Phone:210-521-9330
Mailing Address - Fax:210-521-3817
Practice Address - Street 1:6502 BANDERA ROAD
Practice Address - Street 2:STE 200C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-521-9330
Practice Address - Fax:210-521-3817
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7074101YA0400X
TX11767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125904OtherMHN
TXLP0010117Medicaid
TX5055LCOtherBCBS