Provider Demographics
NPI:1902054505
Name:GOMEZ, GUILLERMO JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 LEE TREVINO BLVD.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4500
Mailing Address - Country:US
Mailing Address - Phone:915-355-0497
Mailing Address - Fax:915-778-4244
Practice Address - Street 1:1790 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4545
Practice Address - Country:US
Practice Address - Phone:915-355-0497
Practice Address - Fax:915-778-4244
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58922101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)