Provider Demographics
NPI:1912359456
Name:GONZALEZ, LORI (LCDC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 DEER CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2763
Mailing Address - Country:US
Mailing Address - Phone:512-767-8042
Mailing Address - Fax:
Practice Address - Street 1:2600 W STASSNEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3401
Practice Address - Country:US
Practice Address - Phone:512-729-8522
Practice Address - Fax:866-653-5142
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12721101YM0800X, 101YA0400X, 101Y00000X
TX76387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional