Provider Demographics
NPI:1932583697
Name:GONZALEZ, JENNIFER LORRAINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LORRAINE
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:477 N COUNTY ROAD 307
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-9387
Mailing Address - Country:US
Mailing Address - Phone:361-244-8648
Mailing Address - Fax:
Practice Address - Street 1:4606 FM 1960 RD W STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4613
Practice Address - Country:US
Practice Address - Phone:361-244-8648
Practice Address - Fax:281-302-4148
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health