Provider Demographics
NPI:1265994883
Name:GAVLICK, DONA (LPC)
Entity type:Individual
Prefix:MS
First Name:DONA
Middle Name:
Last Name:GAVLICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W KAUFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432-3729
Mailing Address - Country:US
Mailing Address - Phone:903-456-6720
Mailing Address - Fax:
Practice Address - Street 1:161 E DALLAS AVE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-2042
Practice Address - Country:US
Practice Address - Phone:903-456-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional