Provider Demographics
NPI:1912693227
Name:PEREZ-GONZALEZ, GUADALUPE L (MA, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:L
Last Name:PEREZ-GONZALEZ
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:LUPITA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC, LCDC
Mailing Address - Street 1:221 BUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 BUR OAK DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6856
Practice Address - Country:US
Practice Address - Phone:956-566-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)