Hodrick, Gwen L

Hodrick, Gwen L is an sole proprietor health care provider with primary practice located at 660 Acoma Blvd N , Lake Havasu City AZ 86403-3662. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Hodrick, Gwen L can be contacted via phone (214) 702-6775.

Contact Information

Primary practice address
660 Acoma Blvd N Lake Havasu City AZ 86403-3662
Phone: (214) 702-6775
Fax: (214) 614-4725
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 12811 Texas
Behavioral Health & Social Service Providers / Professional 101YP2500X 69392 Texas
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 20753 Arizona

Profile Details

NPI number 1194105122
LBN Legal business name Hodrick, Gwen L
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 4th, 2015
Last updated Sep 28th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194105122 NPPES
Arizona MEDICAID 164381

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