Provider Demographics
NPI:1427607431
Name:GONZALEZ, MARCOS D (LPC)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 N STATE HIGHWAY 360 STE 350
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1451
Mailing Address - Country:US
Mailing Address - Phone:682-888-1290
Mailing Address - Fax:940-312-7805
Practice Address - Street 1:2080 N STATE HIGHWAY 360 STE 350
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1451
Practice Address - Country:US
Practice Address - Phone:682-888-1290
Practice Address - Fax:940-312-7805
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional