MEDICARE: DANIELA GONZALEZ LPCS LCDC ICADC SAP

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	79760	TX
2	101YM0800X	Mental Health Counselor	79760	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	15177	TX

General Provider Information

NPI Number	:	1831729755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA GONZALEZ LPCS LCDC ICADC SAP

Provider Business Mailing Address
First Line	:	6510 POLARIS DR STE 1
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2054
Country	:	US
Telephone Number	:	956-962-4198
Fax Number	:	866-387-1142

Provider Business Practice Location Address
First Line	:	6510 POLARIS DR STE 1
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2054
Country	:	US
Telephone Number	:	956-962-4198
Fax Number	:	866-387-1142

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

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	02/08/2026

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