Healthcare Provider Details

I. General information

NPI: 1912634502
Provider Name (Legal Business Name): KRISTINA MARIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 BLANCO RD STE 250
SAN ANTONIO TX
78216-4368
US

IV. Provider business mailing address

7400 BLANCO RD STE 250
SAN ANTONIO TX
78216-4368
US

V. Phone/Fax

Practice location:
  • Phone: 210-446-8255
  • Fax: 888-823-3497
Mailing address:
  • Phone: 210-446-8255
  • Fax: 888-823-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: