MEDICARE: HOLLY GONZALEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18552	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043230014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY GONZALEZ LPC

Provider Business Mailing Address
First Line	:	250 AN COUNTY ROAD 374
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-7089
Country	:	US
Telephone Number	:	903-373-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 E PARK AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4500
Country	:	US
Telephone Number	:	903-731-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/01/2021

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Directions to “ HOLLY GONZALEZ LPC” Practice Location

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