Provider Demographics
NPI:1750491007
Name:GONZALEZ, JOSE ANGEL JR (LPC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
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 1:3007 FRIO PLZ
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-7320
Mailing Address - Country:US
Mailing Address - Phone:956-693-7710
Mailing Address - Fax:956-726-8841
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:SUITE 213
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-727-6016
Practice Address - Fax:956-726-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5729101YA0400X
TX19107101YP2500X, 101YM0800X
101YA0400X, 101YP2500X, 101Y00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179536101Medicaid
TX7292LCOtherBCBS PROVIDER NUMBER