Provider Demographics
NPI:1881380129
Name:GONZALEZ, JORGE E (PHD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 OLD YALE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-3314
Mailing Address - Country:US
Mailing Address - Phone:817-939-7041
Mailing Address - Fax:
Practice Address - Street 1:4349 MARTIN LUTHER KING BLVD HEALTH 2 BLDG SUITE 1001 E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-0001
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical