Provider Demographics
NPI:1750341723
Name:GRADEL, ROBERTA JEANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JEANNE
Last Name:GRADEL
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 1:2310 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-1509
Mailing Address - Country:US
Mailing Address - Phone:512-556-8677
Mailing Address - Fax:
Practice Address - Street 1:1305 S KEY AVE
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3580
Practice Address - Country:US
Practice Address - Phone:512-556-6962
Practice Address - Fax:512-556-4060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80050LOtherBC/BS PREFORMING PROVIDER