Provider Demographics
NPI:1255136750
Name:GONZALES, MARCELA BARRERA (MED, LPC)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:BARRERA
Last Name:GONZALES
Suffix:
Gender:
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BLUE JAY LOOP
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-3298
Mailing Address - Country:US
Mailing Address - Phone:361-652-9162
Mailing Address - Fax:
Practice Address - Street 1:5522 LONE STAR PKWY STE 303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6722
Practice Address - Country:US
Practice Address - Phone:210-664-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health