Provider Demographics
NPI:1861430274
Name:GUDGER, SHARON (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GUDGER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 NW MILITARY HWY
Mailing Address - Street 2:STE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1871
Mailing Address - Country:US
Mailing Address - Phone:210-302-6920
Mailing Address - Fax:210-302-6952
Practice Address - Street 1:12500 NW MILITARY HWY
Practice Address - Street 2:STE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1871
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:210-302-6952
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147841404Medicaid