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General NPI Number Information
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NPI Number | 1194483321
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Entity Type | Organization
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Legal Business Name | JOSE M GOMEZ MA LPC CAADC CCS LLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 30521 SCHOENHERR RD # 200A
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City | WARREN
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State | MI
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Zip | 48088-3161
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Country | US
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Telephone | 248-470-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 14231 NADINE ST
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City | OAK PARK
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State | MI
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Zip | 48237-6932
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Country | US
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Telephone | 248-470-8918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE M GOMEZ
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Credential |
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Telephone | 248-470-8918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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