Healthcare Provider Details

I. General information

NPI: 1740423078
Provider Name (Legal Business Name): ALEX C GONZALEZ LCMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 S OREM BLVD
OREM UT
84058-3101
US

IV. Provider business mailing address

519 S OREM BLVD
OREM UT
84058-3101
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-9292
  • Fax: 801-224-0508
Mailing address:
  • Phone: 801-921-5932
  • Fax: 801-224-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number58906136004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5890613-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: