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General NPI Number Information
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NPI Number | 1639052517
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Entity Type | Individual
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Provider Name | JESSICA JEWETTE GONZALEZ LCDC-I
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 439 MASON PARK BLVD
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City | KATY
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State | TX
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Zip | 77450-6241
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Country | US
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Telephone | 800-685-9796
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Fax |
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Provider Business Mailing Address
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Address Line | 10926 SPANISH GRANT DR
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City | SUGAR LAND
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State | TX
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Zip | 77498-1762
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Country | US
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Telephone | 281-925-8642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 72693
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License Number State | TX
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