Provider Demographics
NPI:1639052517
Name:GONZALEZ, JESSICA JEWETTE (LCDC-I)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEWETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 SPANISH GRANT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1762
Mailing Address - Country:US
Mailing Address - Phone:281-925-8642
Mailing Address - Fax:
Practice Address - Street 1:439 MASON PARK BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6241
Practice Address - Country:US
Practice Address - Phone:800-685-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72693101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)