Healthcare Provider Details

I. General information

NPI: 1609346071
Provider Name (Legal Business Name): LINDA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 W FRANK AVE
LUFKIN TX
75904-3314
US

IV. Provider business mailing address

604 S FREDONIA ST
NACOGDOCHES TX
75961-5528
US

V. Phone/Fax

Practice location:
  • Phone: 936-633-5672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60327
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: