Provider Demographics
NPI:1730388356
Name:GONZALEZ, JUAN FRANCISCO (M ED -LPC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:FRANCISCO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:M ED -LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BALTIC AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7360
Mailing Address - Country:US
Mailing Address - Phone:956-381-1411
Mailing Address - Fax:
Practice Address - Street 1:705 BALTIC AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7360
Practice Address - Country:US
Practice Address - Phone:956-381-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177192Medicaid