Healthcare Provider Details

I. General information

NPI: 1548966864
Provider Name (Legal Business Name): FOUR FALLS CEDAR PARK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 S BAGDAD RD STE 130
LEANDER TX
78641-3577
US

IV. Provider business mailing address

2006 S BAGDAD RD STE 130
LEANDER TX
78641-3577
US

V. Phone/Fax

Practice location:
  • Phone: 512-253-1465
  • Fax: 855-310-6497
Mailing address:
  • Phone: 512-253-1465
  • Fax: 855-310-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KINDRA MICHELLE GONZALEZ
Title or Position: OWNER
Credential: LPC-S
Phone: 512-253-1465