Provider Demographics
NPI:1790433860
Name:GONZALEZ, STEPHANIE LAYNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAYNE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S. LAMAR ST.
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:888-279-0002
Mailing Address - Fax:
Practice Address - Street 1:5373 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5930
Practice Address - Country:US
Practice Address - Phone:888-279-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health