Provider Demographics
NPI:1043943772
Name:GONZALEZ, MARIANA (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 POLARIS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2054
Mailing Address - Country:US
Mailing Address - Phone:956-962-4198
Mailing Address - Fax:
Practice Address - Street 1:6510 POLARIS DR STE 1
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2054
Practice Address - Country:US
Practice Address - Phone:956-962-4198
Practice Address - Fax:866-387-1142
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88676101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health