Provider Demographics
NPI:1497112841
Name:GOMEZ, ETHEL H (LPC)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:H
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ETHEL
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:119 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-6072
Practice Address - Country:US
Practice Address - Phone:830-422-3305
Practice Address - Fax:830-422-3305
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361226902Medicaid
TX71136OtherTX STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS