Provider Demographics
NPI:1669030664
Name:GONZALEZ, PATRICIA DIAN (LPCI)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIAN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 TELGE RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2289
Mailing Address - Country:US
Mailing Address - Phone:713-466-1630
Mailing Address - Fax:
Practice Address - Street 1:823 LIBERTY SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373
Practice Address - Country:US
Practice Address - Phone:281-923-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional