Provider Demographics
NPI:1770342776
Name:GONZALES, LENA (MED,LPC)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 HANNA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6339
Mailing Address - Country:US
Mailing Address - Phone:817-915-1706
Mailing Address - Fax:
Practice Address - Street 1:5691 HANNA CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-6339
Practice Address - Country:US
Practice Address - Phone:817-915-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional