Provider Demographics
NPI:1487987111
Name:KIDD, GAIL (LCDC)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401
Mailing Address - Country:US
Mailing Address - Phone:806-763-7633
Mailing Address - Fax:806-765-0130
Practice Address - Street 1:1614 AVENUE K
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-5042
Practice Address - Country:US
Practice Address - Phone:806-763-7633
Practice Address - Fax:806-765-0130
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07502070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid