Healthcare Provider Details

I. General information

NPI: 1326935255
Provider Name (Legal Business Name): EDITH GISSELLE GONZALEZ RMHCI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SW 1ST ST STE 209
MIAMI FL
33135-2261
US

IV. Provider business mailing address

8004 NW 154TH ST
MIAMI LAKES FL
33016-5814
US

V. Phone/Fax

Practice location:
  • Phone: 786-361-7787
  • Fax: 305-902-3885
Mailing address:
  • Phone: 305-512-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: