Provider Demographics
NPI:1659078566
Name:GONZALEZ-GREEN, GABRIELA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ALEJANDRA
Last Name:GONZALEZ-GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 HIGHLAND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2789
Mailing Address - Country:US
Mailing Address - Phone:346-205-4043
Mailing Address - Fax:
Practice Address - Street 1:4923 HIGHLAND SPRINGS DR
Practice Address - Street 2:
Practice Address - City:BOOTH
Practice Address - State:TX
Practice Address - Zip Code:77469-2789
Practice Address - Country:US
Practice Address - Phone:346-205-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional