=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679452288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTA NICOLE GONZALES-PORRAS LPC- ASSOCIATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16225 PART TEN PL SUITE 870
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-489-8607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12718 AUTUMN GLEN DR
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77498-7362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-500-9366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 99318
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------