Provider Demographics
NPI:1861579187
Name:GONZALES, VERA A (PHD)
Entity type:Individual
Prefix:DR
First Name:VERA
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHD
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 1665
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-1665
Mailing Address - Country:US
Mailing Address - Phone:713-922-4850
Mailing Address - Fax:713-583-5282
Practice Address - Street 1:14100 SOUTHWEST FWY
Practice Address - Street 2:360
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3466
Practice Address - Country:US
Practice Address - Phone:713-922-4850
Practice Address - Fax:713-583-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000011GTOtherBLUE CROSS BLUE SHIELD
TX00112PMedicare ID - Type UnspecifiedLEAGUE CITY NUMBER
TXP22667Medicare UPIN
TX00000011GTOtherBLUE CROSS BLUE SHIELD