Individual
MR. GARY T ONGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LCSW
Contact information
Practice address
1901 CENTRAL DR, STE 315, BEDFORD, TX 76021-5869
(817) 919-7351
(817) 684-9979
Mailing address
2716 RANCHVIEW DR, BURLESON, TX 76028-1534
(817) 919-7351
(817) 336-1740
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
9401
TX
1041C0700X
Clinical Social Worker
Primary
S14689
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014689
STATE LISENCE NUMBER
TX
05
—
064069001
—
TX
01
—
1545LC
BLUE CROSS BLUESHIELD ID
TX
Enumeration date
06/07/2007
Last updated
09/30/2016
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