Provider Demographics
NPI:1831439546
Name:SOUTHWORTH, GREGORY NOEL (LPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:NOEL
Last Name:SOUTHWORTH
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 FRESHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6124
Mailing Address - Country:US
Mailing Address - Phone:817-467-9323
Mailing Address - Fax:
Practice Address - Street 1:422 E LAMAR BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3604
Practice Address - Country:US
Practice Address - Phone:817-751-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional