Provider Demographics
NPI:1154301810
Name:GOMEZ, JAVIER H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:H
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 HARCOURT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3047
Mailing Address - Country:US
Mailing Address - Phone:915-755-1000
Mailing Address - Fax:915-755-1440
Practice Address - Street 1:6455 HILLER
Practice Address - Street 2:STE B-3
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-881-1300
Practice Address - Fax:915-755-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX088341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
84114OtherTRICARE
TX108248904Medicaid
TX158013OtherVALUE OPTIONS
84114OtherTRICARE