Basic Information
| Provider Information | |||||||||
| NPI: | 1306381116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | ALBERT | ||||||||
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| Credential: | LPC / LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8745 COUNTY ROAD 9 S | ||||||||
| Address2: | |||||||||
| City: | ALAMOSA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811019610 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8745 COUNTY ROAD 9 S | ||||||||
| Address2: | |||||||||
| City: | ALAMOSA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195893671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2017 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
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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 | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LPC.0014625 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.