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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194105122 | NPPES |
| Arizona | MEDICAID | 164381 |
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