Healthcare Provider Details

I. General information

NPI: 1700360856
Provider Name (Legal Business Name): MARIA JOSELYN GONZALEZ AMFT/APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 3RD ST
SANTA ROSA CA
95404-4540
US

IV. Provider business mailing address

811 3RD ST
SANTA ROSA CA
95404-4540
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-8405
  • Fax:
Mailing address:
  • Phone: 707-303-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: