Healthcare Provider Details

I. General information

NPI: 1457219206
Provider Name (Legal Business Name): AMY RENEE GONSALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BUSH ST
LEMOORE CA
93245-3601
US

IV. Provider business mailing address

101 E BUSH ST
LEMOORE CA
93245-3601
US

V. Phone/Fax

Practice location:
  • Phone: 559-924-6600
  • Fax:
Mailing address:
  • Phone: 559-924-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: