Provider Demographics
NPI:1962778936
Name:GAMBLE, HATTIE M
Entity type:Individual
Prefix:
First Name:HATTIE
Middle Name:M
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 MOUNT HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77050-5429
Mailing Address - Country:US
Mailing Address - Phone:832-230-1769
Mailing Address - Fax:
Practice Address - Street 1:5823 MOUNT HOUSTON RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77050-5429
Practice Address - Country:US
Practice Address - Phone:832-230-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness