Provider Demographics
NPI:1447506415
Name:BALLESTEROS, JEANETTE GONZALEZ (MS, CRC, LPC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:GONZALEZ
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N 10TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2751
Mailing Address - Country:US
Mailing Address - Phone:956-369-7997
Mailing Address - Fax:
Practice Address - Street 1:5401 N 10TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2751
Practice Address - Country:US
Practice Address - Phone:956-369-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67293101YP2500X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3022824Medicaid