Gjerdevig, Todd Allen

Gjerdevig, Todd Allen is an sole proprietor health care provider with primary practice located at 180 State St Ste 225 , Southlake TX 76092-7632. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Gjerdevig, Todd Allen can be contacted via phone (817) 908-0296.

Contact Information

Primary practice address
180 State St Ste 225 Southlake TX 76092-7632
Phone: (817) 908-0296
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 37507 Texas

Profile Details

NPI number 1073764957
LBN Legal business name Gjerdevig, Todd Allen
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 9th, 2008
Last updated Jan 15th, 2020 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073764957 NPPES
Texas MEDICAID 207198701

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