Provider Demographics
NPI:1861107112
Name:GONZALEZ, ILEANA DANIELLE (LPC)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:DANIELLE
Last Name:GONZALEZ
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 1:4217 MILE 2 1/2 E
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4666
Mailing Address - Country:US
Mailing Address - Phone:512-693-9004
Mailing Address - Fax:
Practice Address - Street 1:4217 MILE 2 1/2 E
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-4666
Practice Address - Country:US
Practice Address - Phone:512-693-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional