MEDICARE: MR. BENANCIO GONZALEZ JR. CASE MANAGEMENT

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	101Y00000X	Counselor	63944	TX
2	101YM0800X	Mental Health Counselor	63944	TX
3	101YP2500X	Professional Counselor	63944	TX
4	171M00000X	Case Manager/Care Coordinator	63944	TX
5	251B00000X	Case Management Agency	63944	TX

General Provider Information

NPI Number	:	1245556422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENANCIO GONZALEZ JR. CASE MANAGEMENT

Provider Business Mailing Address
First Line	:	315 E JACKSON ST STE 4
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-6849
Country	:	US
Telephone Number	:	210-391-7221
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E JACKSON ST STE 4
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-6849
Country	:	US
Telephone Number	:	210-391-7221
Fax Number	:

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

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	03/01/2023

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