Provider Demographics
NPI:1780928465
Name:GONZALES, MARY ISABEL (PYSD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ISABEL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 N ED CAREY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8219
Mailing Address - Country:US
Mailing Address - Phone:956-230-1210
Mailing Address - Fax:956-412-0304
Practice Address - Street 1:1613 WEIGHOST DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-4289
Practice Address - Country:US
Practice Address - Phone:956-542-6296
Practice Address - Fax:956-542-6296
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist