Healthcare Provider Details

I. General information

NPI: 1245855832
Provider Name (Legal Business Name): DAEKIN SHONDAE GONZALES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 TREASURE HILLS BLVD
HARLINGEN TX
78550-8736
US

IV. Provider business mailing address

4237 LAS PALMAS CIR APT 105
BROWNSVILLE TX
78521-3248
US

V. Phone/Fax

Practice location:
  • Phone: 956-366-4500
  • Fax:
Mailing address:
  • Phone: 956-638-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number68849
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: