Provider Demographics
NPI:1285107060
Name:GONZALEZ, LORI LYNNE (LPC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNNE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4856
Mailing Address - Country:US
Mailing Address - Phone:214-435-0014
Mailing Address - Fax:
Practice Address - Street 1:1506 N GREENVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8693
Practice Address - Country:US
Practice Address - Phone:214-509-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional