Provider Demographics
NPI:1366574303
Name:GUIDRY, GWENDOLYN ARNETTA (MBA)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ARNETTA
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 MULBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4078
Mailing Address - Country:US
Mailing Address - Phone:832-310-7796
Mailing Address - Fax:832-987-1688
Practice Address - Street 1:5331 W OREM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5036
Practice Address - Country:US
Practice Address - Phone:832-310-7796
Practice Address - Fax:832-897-1688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454730261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454730Medicare Oscar/Certification