Provider Demographics
NPI:1811786189
Name:GONZALEZ, JOSHUA RAY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RAY
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 JOLLYVILLE RD APT 706
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4861
Mailing Address - Country:US
Mailing Address - Phone:956-422-1674
Mailing Address - Fax:
Practice Address - Street 1:601 S LAKE DESTINY RD STE 300
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7263
Practice Address - Country:US
Practice Address - Phone:512-340-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician