Provider Demographics
NPI:1720300486
Name:GOSNEY, JEFFREY WILLIAM (PHD, LCSW, ICAADC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:GOSNEY
Suffix:
Gender:M
Credentials:PHD, LCSW, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 W BUSINESS 83 LOT 812
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2338
Mailing Address - Country:US
Mailing Address - Phone:956-778-5460
Mailing Address - Fax:
Practice Address - Street 1:9501 W BUSINESS 83 LOT 812
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-2338
Practice Address - Country:US
Practice Address - Phone:956-778-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO205276101YA0400X
MO501699101YA0400X
MO138101YA0400X
TX520261041C0700X
MO0021931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)