Healthcare Provider Details

I. General information

NPI: 1053238790
Provider Name (Legal Business Name): MRS. CORA BROOKE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CORA BROOKE STUCKER

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 COTNER AVE STE 200
LOS ANGELES CA
90025-5664
US

IV. Provider business mailing address

6018 MALTON AVE
SIMI VALLEY CA
93063-3738
US

V. Phone/Fax

Practice location:
  • Phone: 818-335-5200
  • Fax:
Mailing address:
  • Phone: 747-224-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT162318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: