Provider Demographics
NPI:1679579718
Name:ADAM, GWENDOLYN JOY (LMSW, ACP)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:JOY
Last Name:ADAM
Suffix:
Gender:F
Credentials:LMSW, ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TWO GREENWAY PLAZA
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1187
Practice Address - Street 1:6701 FANNIN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-822-4004
Practice Address - Fax:832-825-3689
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159465701Medicaid
TN8A8511Medicare PIN
TX8L5092Medicare PIN
TXP92225Medicare UPIN