Provider Demographics
NPI:1528723632
Name:GONZALEZ, CHRISTINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3748 US HIGHWAY 59 N STE A
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8981
Mailing Address - Country:US
Mailing Address - Phone:936-259-2119
Mailing Address - Fax:936-286-3106
Practice Address - Street 1:3748 US HIGHWAY 59 N STE A
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8981
Practice Address - Country:US
Practice Address - Phone:936-259-2119
Practice Address - Fax:936-286-3106
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77479101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77479OtherSTATE LICENSE