MEDICARE: DR. VALENTINO L GONZALES 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9393	TX
2	101YP2500X	Professional Counselor	61501	TX

General Provider Information

NPI Number	:	1386884922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALENTINO L GONZALES LPC

Provider Business Mailing Address
First Line	:	3217 COLBY CIR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-1875
Country	:	US
Telephone Number	:	469-682-2318
Fax Number	:

Provider Business Practice Location Address
First Line	:	5409 JIM MILLER RD
Second Line	:	SUITE 203A
City	:	DALLAS
State	:	TX
Zip	:	75227
Country	:	US
Telephone Number	:	214-381-8803
Fax Number	:

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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