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General NPI Number Information
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NPI Number | 1285815464
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Entity Type | Individual
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Provider Name | WILLIAM GONZALEZ L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 1100 E DEUCE OF CLUBS STE B
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City | SHOW LOW
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State | AZ
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Zip | 85901-4943
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Country | US
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Telephone | 951-834-3406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440
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City | VERNON
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State | AZ
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Zip | 85940-0440
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Country | US
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Telephone | 951-834-3406
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18312
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License Number State | AZ
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