Provider Demographics
NPI:1962774703
Name:GONZALES, NATALIE R (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:R
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:NATALIA
Other - Middle Name:RENEE
Other - Last Name:CARABAJAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:9523 SAGE TER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4359
Mailing Address - Country:US
Mailing Address - Phone:210-660-8707
Mailing Address - Fax:
Practice Address - Street 1:9523 SAGE TER
Practice Address - Street 2:#100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4359
Practice Address - Country:US
Practice Address - Phone:210-660-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX79538701Medicaid