Provider Demographics
NPI:1043885627
Name:GONZALEZ, JASMINE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 CANALS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0629
Mailing Address - Country:US
Mailing Address - Phone:954-670-3141
Mailing Address - Fax:
Practice Address - Street 1:16610 DALLAS PKWY STE 2100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2690
Practice Address - Country:US
Practice Address - Phone:972-733-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81423101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor