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NPI Code Detail

MEDICARE: BRITTANY GONZALES

MEDICARE:   BRITTANY  GONZALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLMFT-6020ID
2106H00000XMarriage & Family TherapistLAMFT-5411ID
3106H00000XMarriage & Family TherapistLMFT-6020ID

General Provider Information

NPI Number : 1992135743
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY GONZALES
Provider Business Mailing Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-907-1708
Fax Number : 208-939-9009
Provider Business Practice Location Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-907-1708
Fax Number : 208-939-9009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2013
Last Update Date : 04/03/2020

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Directions to “ BRITTANY GONZALES ” Practice Location

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