Healthcare Provider Details

I. General information

NPI: 1114268026
Provider Name (Legal Business Name): EDUARDO WILFREDO GONZALEZ LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MAITLAND CENTER COMMONS BLVD 212
MAITLAND FL
32751-7270
US

IV. Provider business mailing address

452 OSCEOLA ST STE 113
ALTAMONTE SPRINGS FL
32701-7800
US

V. Phone/Fax

Practice location:
  • Phone: 800-840-2528
  • Fax:
Mailing address:
  • Phone: 321-320-3782
  • Fax: 386-218-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: