Healthcare Provider Details

I. General information

NPI: 1740423607
Provider Name (Legal Business Name): LAURA GONZALES, M.A., L.P.C., N.C.C., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 W UNION HILLS DR SUITE 105
PEORIA AZ
85382-3029
US

IV. Provider business mailing address

34108 N 26TH AVE
PHOENIX AZ
85085-5070
US

V. Phone/Fax

Practice location:
  • Phone: 602-717-7213
  • Fax: 623-566-2062
Mailing address:
  • Phone: 602-717-7213
  • Fax: 623-566-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC13196
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC13196
License Number StateAZ

VIII. Authorized Official

Name: MS. LAURA GENEVA GONZALES
Title or Position: OWNER/MEMBER
Credential: MA, LPC, NCC, IMH-E
Phone: 602-327-0834