Provider Demographics
NPI:1376202200
Name:GONZALEZ, EVELYN (LPC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:GONZALEZ
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 1:4102 S NEW BRAUNFELS AVE STE 110-191
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1707
Mailing Address - Country:US
Mailing Address - Phone:210-692-4568
Mailing Address - Fax:
Practice Address - Street 1:12030 BANDERA RD STE D
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4735
Practice Address - Country:US
Practice Address - Phone:210-523-4200
Practice Address - Fax:210-692-4568
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional