Provider Demographics
NPI:1942521224
Name:DERDERIAN, GREGORY ALEXANDER (LMFT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:DERDERIAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 SPRING CYPRESS RD STE L-199
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3194
Mailing Address - Country:US
Mailing Address - Phone:806-370-7435
Mailing Address - Fax:
Practice Address - Street 1:8765 SPRING CYPRESS RD STE L-199
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3194
Practice Address - Country:US
Practice Address - Phone:806-370-7435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist