Provider Demographics
NPI:1104925296
Name:SPURGEON, GAILANE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:GAILANE
Middle Name:MARIE
Last Name:SPURGEON
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 1:15 TONTO CIR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 262
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2139
Practice Address - Country:US
Practice Address - Phone:361-570-8900
Practice Address - Fax:361-570-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83165LOtherBLUECROSS/BLUESHIELD