Basic Information
| Provider Information | |||||||||
| NPI: | 1205375367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | YXIS | ||||||||
| MiddleName: | CARMEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 W 70TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165488 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7875 NW 12TH ST | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865054449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 101Y00000X | IMH20193 | FL | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.