Provider Demographics
NPI:1831266295
Name:BRONSON, GENE (TX LPC 14451)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:
Last Name:BRONSON
Suffix:
Gender:M
Credentials:TX LPC 14451
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-7629
Mailing Address - Country:US
Mailing Address - Phone:903-918-3626
Mailing Address - Fax:903-297-8053
Practice Address - Street 1:4715 TENNERYVILLE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1537
Practice Address - Country:US
Practice Address - Phone:903-297-2138
Practice Address - Fax:903-297-8053
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 14451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional