=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376435115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCO GONZALEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S TAYLOR STREET SUITE 600 - LIVEWELL COUNSELING
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-316-5595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S TAYLOR STREET SUITE 600 - LIVEWELL COUNSELING
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-316-5595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 88969
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------