Provider Demographics
NPI:1700536554
Name:GASHO, ARZA LEON (LCDC)
Entity type:Individual
Prefix:MR
First Name:ARZA
Middle Name:LEON
Last Name:GASHO
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3006
Mailing Address - Country:US
Mailing Address - Phone:512-399-9757
Mailing Address - Fax:512-399-9747
Practice Address - Street 1:305 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3006
Practice Address - Country:US
Practice Address - Phone:512-399-9757
Practice Address - Fax:512-399-9747
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12974101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)