Provider Demographics
NPI:1619662269
Name:GONZALES, MARCUS ANTHONY (RBT-23-266695)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:ANTHONY
Last Name:GONZALES
Suffix:
Gender:M
Credentials:RBT-23-266695
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 THOUSAND OAKS DR # 1301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6974
Mailing Address - Country:US
Mailing Address - Phone:726-215-6448
Mailing Address - Fax:
Practice Address - Street 1:5210 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6974
Practice Address - Country:US
Practice Address - Phone:737-242-7925
Practice Address - Fax:726-204-8637
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-266695106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician