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General NPI Number Information
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NPI Number | 1275918930
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Entity Type | Individual
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Provider Name | LYNETTE GONZALES M.ED.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 431 CHEYENNE AVE
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City | EATON
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State | CO
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Zip | 80615-3471
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Country | US
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Telephone | 970-454-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 3727 DALTON DR
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City | FORT COLLINS
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State | CO
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Zip | 80526-5373
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Country | US
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Telephone | 970-978-5878
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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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