Provider Demographics
NPI:1366850869
Name:GONZALES, TERI JO (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:JO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 EL PASO AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-5825
Mailing Address - Country:US
Mailing Address - Phone:325-207-6036
Mailing Address - Fax:
Practice Address - Street 1:4705 EL PASO AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-5825
Practice Address - Country:US
Practice Address - Phone:325-207-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health