Provider Demographics
NPI:1306578943
Name:GONZALEZ, JOSE GUSTAVO (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GUSTAVO
Last Name:GONZALEZ
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 1:27218 MCLELLAND DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2096
Mailing Address - Country:US
Mailing Address - Phone:956-343-3755
Mailing Address - Fax:
Practice Address - Street 1:27218 MCLELLAND DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-2096
Practice Address - Country:US
Practice Address - Phone:956-343-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical