Provider Demographics
NPI:1316661572
Name:GONZALES, ESTEVAN (LPC)
Entity type:Individual
Prefix:
First Name:ESTEVAN
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S GEORGIA ST STE C-2
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4858
Mailing Address - Country:US
Mailing Address - Phone:806-553-0172
Mailing Address - Fax:
Practice Address - Street 1:3601 S GEORGIA ST STE C-2
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4858
Practice Address - Country:US
Practice Address - Phone:806-553-0172
Practice Address - Fax:806-553-0952
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health