Provider Demographics
NPI:1295321503
Name:GADDIS, STEVEN B (LPC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:B
Last Name:GADDIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 CAPETOWN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8839
Mailing Address - Country:US
Mailing Address - Phone:936-463-8335
Mailing Address - Fax:
Practice Address - Street 1:287 CAPETOWN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-8839
Practice Address - Country:US
Practice Address - Phone:936-463-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional