Provider Demographics
NPI:1528224680
Name:GONZALEZ, CHRISTINE M (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5164
Mailing Address - Country:US
Mailing Address - Phone:972-771-3969
Mailing Address - Fax:972-771-8258
Practice Address - Street 1:2237 RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087
Practice Address - Country:US
Practice Address - Phone:972-771-3969
Practice Address - Fax:972-771-8258
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31348OtherTEXAS PSYCHOLOGY LICENSE