Provider Demographics
NPI:1700899234
Name:GUCKER, GALE T (LPC)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:T
Last Name:GUCKER
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 1:4318 CLINGMAN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3208
Mailing Address - Country:US
Mailing Address - Phone:318-424-0315
Mailing Address - Fax:318-865-1899
Practice Address - Street 1:820 JORDAN ST STE 475
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4524
Practice Address - Country:US
Practice Address - Phone:318-424-0315
Practice Address - Fax:318-865-1899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA690101YP2500X
IN20050059A103T00000X
LAMFT503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist