Provider Demographics
NPI:1356529127
Name:GERARD-GOVEA, RORY GIL (LPC, CADC I, LMHC)
Entity type:Individual
Prefix:MR
First Name:RORY
Middle Name:GIL
Last Name:GERARD-GOVEA
Suffix:
Gender:M
Credentials:LPC, CADC I, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 JOHN ARDEN DR APT 145
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4631
Mailing Address - Country:US
Mailing Address - Phone:503-515-2545
Mailing Address - Fax:503-961-9858
Practice Address - Street 1:1831 JOHN ARDEN DR APT 145
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4631
Practice Address - Country:US
Practice Address - Phone:503-515-2545
Practice Address - Fax:503-961-9858
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-03-20101YA0400X
ORC-3025101YM0800X
WALH60572587101YP2500X, 101YM0800X
ORC 3025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653546Medicaid