Provider Demographics
NPI:1972045763
Name:GONZALEZ, SHANDY ANNETTE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHANDY
Middle Name:ANNETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3974
Mailing Address - Country:US
Mailing Address - Phone:956-362-3520
Mailing Address - Fax:956-362-3529
Practice Address - Street 1:1000 E DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3974
Practice Address - Country:US
Practice Address - Phone:956-362-3520
Practice Address - Fax:956-362-3529
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional