Provider Demographics
NPI:1013765338
Name:GONZALES, DYLAN J (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:J
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEMOCRACY DR STE 255
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3699
Mailing Address - Country:US
Mailing Address - Phone:940-765-9029
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR
Practice Address - Street 2:255
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3699
Practice Address - Country:US
Practice Address - Phone:940-765-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health