Provider Demographics
NPI:1326658055
Name:GONZALEZ, KINDRA MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:MICHELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 MINERVA CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W WHITESTONE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2271
Practice Address - Country:US
Practice Address - Phone:512-859-5729
Practice Address - Fax:737-252-5011
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional