Provider Demographics
NPI:1982138673
Name:GONZALES, CAROLINE KAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:KAY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA RD STE 200E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1454
Mailing Address - Country:US
Mailing Address - Phone:210-842-1777
Mailing Address - Fax:210-579-7755
Practice Address - Street 1:6502 BANDERA RD STE 200E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1454
Practice Address - Country:US
Practice Address - Phone:210-842-1777
Practice Address - Fax:210-579-7755
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77417101YP2500X, 101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral