Provider Demographics
NPI:1407604440
Name:GONZALES MCDONOUGH, REBECCA (MS, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GONZALES MCDONOUGH
Suffix:
Gender:F
Credentials:MS, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 DEEPDALE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3108
Mailing Address - Country:US
Mailing Address - Phone:361-739-0049
Mailing Address - Fax:
Practice Address - Street 1:5030 HOLLY RD STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4759
Practice Address - Country:US
Practice Address - Phone:361-739-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional