Provider Demographics
NPI:1457730533
Name:GONZALEZ, STACY SPEEDLIN (PHD, LPC-S, LCDC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:SPEEDLIN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD, LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 MEDICAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5635
Mailing Address - Country:US
Mailing Address - Phone:830-377-0713
Mailing Address - Fax:210-615-1122
Practice Address - Street 1:4115 MEDICAL DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5635
Practice Address - Country:US
Practice Address - Phone:830-377-0713
Practice Address - Fax:210-615-1122
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12679101YA0400X
TX71780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)