Provider Demographics
NPI:1346853918
Name:GONGORA, CYNTHIA (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GONGORA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 DORA JEANNE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3377
Mailing Address - Country:US
Mailing Address - Phone:956-624-9555
Mailing Address - Fax:956-386-0006
Practice Address - Street 1:1512 E GRIFFIN PKWY # 8
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2416
Practice Address - Country:US
Practice Address - Phone:956-424-3433
Practice Address - Fax:956-424-3799
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX79884OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX01844571OtherTEXAS DPS