Provider Demographics
NPI:1750324778
Name:GONZALEZ, FERNANDO JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 HUEBNER RD.
Mailing Address - Street 2:#210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-724-3455
Mailing Address - Fax:210-641-2099
Practice Address - Street 1:9150 HUEBNER RD.
Practice Address - Street 2:#210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-724-3455
Practice Address - Fax:210-641-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178123902Medicaid
TX1781239-03Medicaid
TX178123901Medicaid