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General NPI Number Information
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NPI Number | 1114268026
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Entity Type | Individual
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Provider Name | EDUARDO WILFREDO GONZALEZ LMHC
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Gender | Male
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1009 MAITLAND CENTER COMMONS BLVD 212
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City | MAITLAND
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State | FL
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Zip | 32751-7270
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Country | US
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Telephone | 800-840-2528
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Fax |
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Provider Business Mailing Address
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Address Line | 452 OSCEOLA ST STE 113
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7800
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Country | US
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Telephone | 321-320-3782
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Fax | 386-218-0632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16841
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License Number State | FL
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