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General NPI Number Information
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NPI Number | 1275397804
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Entity Type | Individual
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Provider Name | CHANTAL ALEXIS GONZALEZ AMFT #143394
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Gender | Female
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 3415 OVERLAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-5405
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Country | US
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Telephone | 800-530-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3852 VINTON AVE APT 104
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City | CULVER CITY
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State | CA
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Zip | 90232-3184
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Country | US
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Telephone | 805-636-0200
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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