Healthcare Provider Details

I. General information

NPI: 1285123737
Provider Name (Legal Business Name): VINCENT LOUIS GONZALEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT LOUIS GONZALEZ

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5107
US

IV. Provider business mailing address

1123 E OKLAHOMA AVE
GUTHRIE OK
73044-3752
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-760-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22044
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: