MEDICARE: DR. ERICK JOHN GONZALEZ PSY.D.

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	103T00000X	Psychologist	31529	TX

General Provider Information

NPI Number	:	1568517035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICK JOHN GONZALEZ PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 1486
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-0024
Country	:	US
Telephone Number	:	972-727-3627
Fax Number	:	972-390-2302

Provider Business Practice Location Address
First Line	:	400 N ALLEN DR
Second Line	:	SUITE 208
City	:	ALLEN
State	:	TX
Zip	:	75013-2555
Country	:	US
Telephone Number	:	972-727-3627
Fax Number	:	972-390-2302

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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