Provider Demographics
NPI:1336570704
Name:GOMEZ, ELSA ERIKA (MA, LPC, LPCC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:ERIKA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8461 CASTNER DR TRLR 71
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-1612
Mailing Address - Country:US
Mailing Address - Phone:915-478-2441
Mailing Address - Fax:915-850-0249
Practice Address - Street 1:5760 W LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-1112
Practice Address - Country:US
Practice Address - Phone:281-707-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0809101YP2500X
TX11367101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26823772Medicaid
TX152192402Medicaid