Provider Demographics
NPI:1598716086
Name:GOMEZ, ANNA D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:D
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:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-1254
Mailing Address - Country:US
Mailing Address - Phone:956-546-6100
Mailing Address - Fax:877-808-8344
Practice Address - Street 1:2905 CENTRAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3919
Practice Address - Country:US
Practice Address - Phone:956-546-6100
Practice Address - Fax:877-808-8344
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0270878-01Medicaid