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General NPI Number Information
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NPI Number | 1285511774
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Entity Type | Individual
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Provider Name | ALICIA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 575 WHITE AVE
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City | WEED
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State | CA
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Zip | 96094-2431
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Country | US
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Telephone | 530-598-9728
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Fax |
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Provider Business Mailing Address
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Address Line | 609 SUNSET DR
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-9106
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Country | US
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Telephone | 530-351-8292
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT154362
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License Number State | CA
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