| Todd Gjerdevig | |
|
1111 S Main St Suite 132 Grapevine TX 76051-5577 | |
| (817) 865-5032 | |
| Not Available |
| Full Name | Todd Gjerdevig |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1111 S Main St, Grapevine, Texas |
| Authorized Official Name and Position | Todd Gjerdevig (OWNER) |
| Authorized Official Contact | 8179080296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Todd Gjerdevig 1111 S Main St Suite 132 Grapevine TX 76051-5577 Ph: (817) 865-5032 | Todd Gjerdevig 1111 S Main St Suite 132 Grapevine TX 76051-5577 Ph: (817) 865-5032 |
| NPI Number | 1376938613 |
|---|---|
| Provider Enumeration Date | 04/03/2015 |
| Last Update Date | 04/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376938613 | NPI | - | NPPES |
| 207198701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 37507 (Texas) | Primary |
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