Healthcare Provider Details

I. General information

NPI: 1346745379
Provider Name (Legal Business Name): CELY MARIE GONZALEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PARK CENTER DR STE 7
ORLANDO FL
32835-5700
US

IV. Provider business mailing address

4367 THORNBRIAR LN APT 203
ORLANDO FL
32822-2277
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3554
  • Fax: 407-601-3992
Mailing address:
  • Phone: 321-948-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberIMH15545
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH15545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: