Provider Demographics
NPI:1912242553
Name:VALENZUELA, GABRIELA (LPC, MS)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:STE 14
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-362-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358235201Medicaid