Basic Information
| Provider Information | |||||||||
| NPI: | 1760976468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 E IDAHO AVE STE 2B-E | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755569585 | ||||||||
| FaxNumber: | 5755569456 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 E IDAHO AVE STE 2B-E | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755569585 | ||||||||
| FaxNumber: | 5755569456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2018 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CTL0197201 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.