Provider Demographics
NPI:1356515670
Name:GONZALEZ, PALMIRA (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:PALMIRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-0658
Mailing Address - Country:US
Mailing Address - Phone:956-500-2429
Mailing Address - Fax:956-488-2600
Practice Address - Street 1:104 N TEXAS ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3628
Practice Address - Country:US
Practice Address - Phone:956-500-2429
Practice Address - Fax:956-488-2600
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192333601Medicaid
TX192332801Medicaid