Provider Demographics
NPI:1033664313
Name:GONZALEZ, MARIO JULIAN (LPC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JULIAN
Last Name:GONZALEZ
Suffix:
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 1:802 WILD PETUNIA WAY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4184
Mailing Address - Country:US
Mailing Address - Phone:281-685-6827
Mailing Address - Fax:
Practice Address - Street 1:2201 DOUBLE CREEK DR
Practice Address - Street 2:UNIT 1003
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3836
Practice Address - Country:US
Practice Address - Phone:512-677-4183
Practice Address - Fax:866-617-5633
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health