Provider Demographics
NPI:1356858302
Name:GOMEZ, GERALDINE A (LPC-S, ATR-BC)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LPC-S, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5885
Mailing Address - Country:US
Mailing Address - Phone:346-758-1812
Mailing Address - Fax:
Practice Address - Street 1:10401 S MASON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5885
Practice Address - Country:US
Practice Address - Phone:346-758-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74350101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health