Provider Demographics
NPI:1265735856
Name:CHAMPION, GLORIA AURORA (LPC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:AURORA
Last Name:CHAMPION
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 1:8310 LAMOND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3195
Mailing Address - Country:US
Mailing Address - Phone:281-861-7326
Mailing Address - Fax:
Practice Address - Street 1:12816 WILLOW CENTRE DR STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-3034
Practice Address - Country:US
Practice Address - Phone:346-235-3939
Practice Address - Fax:346-235-3938
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372592101Medicaid
TX218699105Medicaid
TX218699104Medicaid