Healthcare Provider Details

I. General information

NPI: 1245987064
Provider Name (Legal Business Name): ASHLEY GONZALEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY TREVINO

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 E US HIGHWAY 83
RIO GRANDE CITY TX
78582-9417
US

IV. Provider business mailing address

5048 E US HIGHWAY 83 STE 4
RIO GRANDE CITY TX
78582-9417
US

V. Phone/Fax

Practice location:
  • Phone: 956-256-1643
  • Fax:
Mailing address:
  • Phone: 956-370-8661
  • Fax: 956-899-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number93731
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number93731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: