Healthcare Provider Details

I. General information

NPI: 1386775351
Provider Name (Legal Business Name): CORINNE GONZALEZ M.S., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E PACIFIC COAST HWY 210
LONG BEACH CA
90804-3279
US

IV. Provider business mailing address

5225 E KILLDEE ST
LONG BEACH CA
90808-3419
US

V. Phone/Fax

Practice location:
  • Phone: 562-505-7586
  • Fax: 562-490-7681
Mailing address:
  • Phone: 562-421-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 45897
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF47632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: