Provider Demographics
NPI:1477951358
Name:GOMEZ, ROCIO (LPC)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:GOMEZ
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 1:1605 GEORGE DIETER DR STE 636
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5600
Mailing Address - Country:US
Mailing Address - Phone:915-671-1371
Mailing Address - Fax:915-219-9022
Practice Address - Street 1:1370 PULLMAN DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7788
Practice Address - Country:US
Practice Address - Phone:915-801-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341651305Medicaid