Provider Demographics
NPI:1528293370
Name:GAULT, ANNE PRESCOTT (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:PRESCOTT
Last Name:GAULT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 N JUPITER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6563
Mailing Address - Country:US
Mailing Address - Phone:214-924-5829
Mailing Address - Fax:
Practice Address - Street 1:3112 N JUPITER RD STE 203
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6563
Practice Address - Country:US
Practice Address - Phone:214-924-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC #58190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional