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General NPI Number Information
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NPI Number | 1154773190
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Entity Type | Individual
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Provider Name | LISA GAFFNEY-GONZALEZ CMHC, SUDC,
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Gender | Female
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 4505 S WASATCH BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-4709
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Country | US
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Telephone | 801-448-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 3148 S 1100 W
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3304
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Country | US
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Telephone |
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Fax |
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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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