Provider Demographics
NPI:1760675094
Name:GAMBILL, JOHN DAVID (LCDC, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:GAMBILL
Suffix:
Gender:M
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BEAU DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8629
Mailing Address - Country:US
Mailing Address - Phone:214-264-7404
Mailing Address - Fax:
Practice Address - Street 1:109 N JACKSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4469
Practice Address - Country:US
Practice Address - Phone:214-264-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12077101YA0400X
TX92764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)