Basic Information
| Provider Information | |||||||||
| NPI: | 1275037830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | LCMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5097 W CLOUD ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674019743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8578250563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 CLAFLIN RD | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2950 | KS | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 03094 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.