MEDICARE: STEPHANIE LAYNE GONZALEZ PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61437110	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209026430	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10845	MN
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1073426	TX

General Provider Information

NPI Number	:	1790433860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LAYNE GONZALEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	202 S. LAMAR ST.
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	888-279-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	5373 W ALABAMA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5930
Country	:	US
Telephone Number	:	888-279-0002
Fax Number	:

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

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	12/09/2025

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