Healthcare Provider Details

I. General information

NPI: 1760976468
Provider Name (Legal Business Name): MARIA DE JESUS GONZALEZ LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N CHURCH ST
LAS CRUCES NM
88001-3440
US

IV. Provider business mailing address

530 N CHURCH ST
LAS CRUCES NM
88001-3440
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-9878
  • Fax:
Mailing address:
  • Phone: 575-526-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0198
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: