Provider Demographics
NPI:1659042513
Name:GONZALEZ, KATELYNNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2819
Mailing Address - Country:US
Mailing Address - Phone:409-267-4126
Mailing Address - Fax:
Practice Address - Street 1:101 S PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2819
Practice Address - Country:US
Practice Address - Phone:409-267-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional