Individual provider Active NPI

Tyffany Marie Gonzalez, LCSW

  • Clinical Social Worker
  • Houston, TX
National Provider Identifier
1740003862
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
65397 Issued in TX
Practice address
4635 Southwest Fwy Ste 635
Houston, TX 77027-7112
Phone
(713) 850-0049
NPI assigned
Nov 6, 2024
Last updated
Nov 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 65397 TX Primary

Addresses

Primary practice location

4635 Southwest Fwy Ste 635
Houston, TX 77027-7112

Mailing address

4635 Southwest Fwy Ste 635
Houston, TX 77027-7112
Phone (713) 850-0049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241116000242 TX Practitioner - Clinical Social Worker 0648704353 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
65397TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Psychological Care Sa I, LLC Clinical CurrentSince Nov 4, 2024 Accepting new patients

Locations

11127 Circle Dr
Austin, TX 78736
Phone (512) 288-8844

4635 Southwest Fwy
Ste 635
Houston, TX 77027
Phone (281) 759-2900

5027 Pecan Grove Blvd
San Antonio, TX 78222
Phone (210) 333-6815

616 W Russell Pl
San Antonio, TX 78212
Phone (210) 725-9233

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1740003862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4635 SOUTHWEST FWY STE 635",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770277112",
            "telephone_number": "713-850-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 SOUTHWEST FWY STE 635",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770277112",
            "telephone_number": "713-850-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "TYFFANY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "65397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.