Provider Demographics
NPI:1669759551
Name:GONZALES, LEROY (LPC)
Entity type:Individual
Prefix:MR
First Name:LEROY
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 1:6304 CARNATION LN
Mailing Address - Street 2:
Mailing Address - City:BLEIBLERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78931-5005
Mailing Address - Country:US
Mailing Address - Phone:281-450-8786
Mailing Address - Fax:281-450-8786
Practice Address - Street 1:102 E ALAMO ST
Practice Address - Street 2:SUITE 200 B
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3792
Practice Address - Country:US
Practice Address - Phone:979-830-8800
Practice Address - Fax:979-830-8800
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64543101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)