Provider Demographics
NPI:1700170610
Name:FUERZA DE LOS CHICANOS
Entity Type:Organization
Organization Name:FUERZA DE LOS CHICANOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:817-504-4270
Mailing Address - Street 1:623 W MAIN ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1047
Mailing Address - Country:US
Mailing Address - Phone:817-504-4270
Mailing Address - Fax:
Practice Address - Street 1:623 W MAIN ST
Practice Address - Street 2:SUITE 316
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1047
Practice Address - Country:US
Practice Address - Phone:817-504-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty