Provider Demographics
NPI:1326830332
Name:PAULK, GAGE (LCDC)
Entity type:Individual
Prefix:
First Name:GAGE
Middle Name:
Last Name:PAULK
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 FREMONT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6200
Mailing Address - Country:US
Mailing Address - Phone:806-759-3434
Mailing Address - Fax:
Practice Address - Street 1:6917 FREMONT AVE APT B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6200
Practice Address - Country:US
Practice Address - Phone:806-759-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)