Individual
BOBBY GORDON NIEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L. P .C.
Contact information
Practice address
1500 NORWOOD DR STE 205B, HURST, TX 76054-3644
(817) 729-6333
(817) 282-1683
Mailing address
608 AUTUMN LEAVES TRAIL, IRVING, TX 75060-2004
(972) 790-0032
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11725
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221762
MANAGED HEALTH NETWORK
CA
01
—
2253LC
BLUE CROSS/BLUE SHIELD
TX
05
—
LP0008546
—
TX
Enumeration date
10/03/2006
Last updated
03/13/2008
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