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General NPI Number Information
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NPI Number | 1285123737
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Entity Type | Individual
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Provider Name | VINCENT LOUIS GONZALEZ A.A. PSYCHOLOGY
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Gender | Male
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 4300 N LINCOLN BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-5107
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Country | US
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Telephone | 405-424-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 NW 51ST ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5608
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Country | US
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Telephone | 405-760-8292
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8605
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License Number State | OK
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