Basic Information
| Provider Information | |||||||||
| NPI: | 1003388406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEMAN | ||||||||
| FirstName: | GUSTAVO | ||||||||
| MiddleName: | ALCANTAR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2815 TOLAR STREET | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146327574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4730 COLLEGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2018 | ||||||||
| LastUpdateDate: | 12/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP139970 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.