Healthcare Provider Details

I. General information

NPI: 1326383738
Provider Name (Legal Business Name): JESSICA ALEXANDRA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

IV. Provider business mailing address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-6697
  • Fax:
Mailing address:
  • Phone: 559-549-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: