Healthcare Provider Details

I. General information

NPI: 1184901639
Provider Name (Legal Business Name): MARIEL GONZALEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 1ST ST
SLIDELL LA
70458-3606
US

IV. Provider business mailing address

62220 HIGHWAY 1091
PEARL RIVER LA
70452-3384
US

V. Phone/Fax

Practice location:
  • Phone: 985-690-6622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5169
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: