Provider Demographics
NPI:1417344961
Name:GONZALEZ, GERARDO JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23119 IH 10 W BLDG 7
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1767
Mailing Address - Country:US
Mailing Address - Phone:210-994-6336
Mailing Address - Fax:210-994-6441
Practice Address - Street 1:23119 IH 10 W BLDG 7
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1767
Practice Address - Country:US
Practice Address - Phone:210-994-6336
Practice Address - Fax:210-994-6441
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1949103TC1900X
TX38590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling