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Organization
TODD GJERDEVIG
Active
Organization
TODD GJERDEVIG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD GJERDEVIG LCSW (OWNER)
(817) 908-0296
Entity
Organization
Contact information
Practice address
1111 S MAIN ST, SUITE 132, GRAPEVINE, TX 76051-5577
(817) 865-5032
Mailing address
1111 S MAIN ST, SUITE 132, GRAPEVINE, TX 76051-5577
(817) 865-5032
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
37507
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207198701
—
TX
Enumeration date
04/03/2015
Last updated
04/03/2015
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