MEDICARE: EFRAIN GONZALEZ MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19200	TX

General Provider Information

NPI Number	:	1558380113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFRAIN GONZALEZ MA, LPC

Provider Business Mailing Address
First Line	:	1160 DAIRY ASHFORD RD STE 601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3022
Country	:	US
Telephone Number	:	281-645-5264
Fax Number	:	210-582-6463

Provider Business Practice Location Address
First Line	:	1160 DAIRY ASHFORD RD STE 601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3022
Country	:	US
Telephone Number	:	281-645-5264
Fax Number	:	210-582-6463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/09/2024

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