Provider Demographics
NPI:1225609332
Name:GONZALES, CHRISTINE HERRERA (RBT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:HERRERA
Last Name:GONZALES
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-3571
Mailing Address - Country:US
Mailing Address - Phone:512-923-9283
Mailing Address - Fax:
Practice Address - Street 1:519 VANCE ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-3571
Practice Address - Country:US
Practice Address - Phone:512-923-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-173594106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician