Provider Demographics
NPI:1750102299
Name:GONZALEZ QUEZADA, GUADALUPE (LMSW)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GONZALEZ QUEZADA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14960 HARRY FLOURNOY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-1047
Mailing Address - Country:US
Mailing Address - Phone:915-549-2144
Mailing Address - Fax:
Practice Address - Street 1:14960 HARRY FLOURNOY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-1047
Practice Address - Country:US
Practice Address - Phone:915-549-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105668104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker