Healthcare Provider Details

I. General information

NPI: 1679516876
Provider Name (Legal Business Name): SANDRA GONZALES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DON PASQUAL NW
LOS LUNAS NM
87031
US

IV. Provider business mailing address

PO BOX 518
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-865-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR20382
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR20382
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: