Provider Demographics
NPI:1407366651
Name:GONZALES, YOLANDA GAIL (LPC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:GAIL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:GAIL
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22522 CARRIAGE BUSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-4419
Mailing Address - Country:US
Mailing Address - Phone:956-639-2355
Mailing Address - Fax:956-639-2355
Practice Address - Street 1:22522 CARRIAGE BUSH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-4419
Practice Address - Country:US
Practice Address - Phone:956-639-2355
Practice Address - Fax:956-639-2355
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX101YS0200X
TX74865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool