Provider Demographics
NPI:1154436657
Name:GOMEZ, SIXTO GONZALES (LCSW)
Entity type:Individual
Prefix:
First Name:SIXTO
Middle Name:GONZALES
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9771 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6832
Mailing Address - Country:US
Mailing Address - Phone:915-590-3330
Mailing Address - Fax:915-594-8245
Practice Address - Street 1:9771 EASTRIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6832
Practice Address - Country:US
Practice Address - Phone:915-590-3330
Practice Address - Fax:915-594-8245
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS191381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S01RMedicare ID - Type Unspecified