Provider Demographics
NPI:1457946295
Name:GONZALEZ, ANDREA M
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PAESANOS PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1266
Mailing Address - Country:US
Mailing Address - Phone:210-481-4265
Mailing Address - Fax:210-851-8374
Practice Address - Street 1:3519 PAESANOS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1266
Practice Address - Country:US
Practice Address - Phone:210-481-4265
Practice Address - Fax:210-851-8374
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist