Individual provider · Type 1 NPI
Gideon Petrus Botha, LPC, LMFT
Professional Counselor · League City, TX
NPI number
1356460414
Active
Practice location
2160 Brittany Colony Dr
League City, TX 77573-6246
Fax (281) 316-0548
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Marriage & Family Therapist | 106H00000X | 200848 (TX) |
| Professional Counselor Primary | 101YP2500X | 61340 (TX) |
Professional Counselor: Definition to come...
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About NPI 1356460414
Gideon Petrus Botha, LPC, LMFT's National Provider Identifier is 1356460414, issued on Mar 28, 2007. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in League City, TX. The record was last updated on Apr 23, 2012.