Provider Demographics
NPI:1245556422
Name:GONZALEZ, BENANCIO JR (CASE MANAGEMENT)
Entity type:Individual
Prefix:MR
First Name:BENANCIO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E JACKSON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6849
Mailing Address - Country:US
Mailing Address - Phone:210-391-7221
Mailing Address - Fax:
Practice Address - Street 1:315 E JACKSON ST STE 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6849
Practice Address - Country:US
Practice Address - Phone:210-391-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63944101Y00000X, 101YM0800X, 101YP2500X, 171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator