Provider Demographics
NPI:1740511179
Name:GONZALEZ, JESUS JESSE (LPC)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:JESSE
Last Name:GONZALEZ
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 1:6006 REIGER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4581
Mailing Address - Country:US
Mailing Address - Phone:214-941-0798
Mailing Address - Fax:214-941-0408
Practice Address - Street 1:6006 REIGER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4581
Practice Address - Country:US
Practice Address - Phone:214-941-0798
Practice Address - Fax:214-941-0408
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13649101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health