Provider Demographics
NPI:1033770367
Name:GONZALEZ, JUAN ANTONIO LOERA (LPCC 16813)
Entity type:Individual
Prefix:
First Name:JUAN ANTONIO
Middle Name:LOERA
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPCC 16813
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 CLEARWATER ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7472
Mailing Address - Country:US
Mailing Address - Phone:559-202-6189
Mailing Address - Fax:
Practice Address - Street 1:1055 W HENDERSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1490
Practice Address - Country:US
Practice Address - Phone:559-788-1200
Practice Address - Fax:559-713-3717
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6611101YM0800X, 101YP2500X
CA16813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health