Provider Demographics
NPI:1457788077
Name:GONZALES, PETE (LPC)
Entity Type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15012 LEMOYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5205
Mailing Address - Country:US
Mailing Address - Phone:228-396-2206
Mailing Address - Fax:228-396-1141
Practice Address - Street 1:15012 LEMOYNE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5205
Practice Address - Country:US
Practice Address - Phone:228-396-2206
Practice Address - Fax:228-396-1141
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional