MEDICARE: BASTI GONZALEZ LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14248	TX
2	1041C0700X	Clinical Social Worker	110920	TX

General Provider Information

NPI Number	:	1053260182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASTI GONZALEZ LCSW

Provider Business Mailing Address
First Line	:	7005 JERICHO TREE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3322
Country	:	US
Telephone Number	:	915-630-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 JERICHO TREE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3322
Country	:	US
Telephone Number	:	915-630-6177
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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