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General NPI Number Information
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NPI Number | 1326737305
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Entity Type | Individual
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Provider Name | MRS. JESSICA GONZALES
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Gender | Female
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 1627 S HARGRAVE ST
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City | BANNING
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State | CA
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Zip | 92220-6169
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Country | US
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Telephone | 951-955-1625
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Fax |
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Provider Business Mailing Address
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Address Line | 15982 LASSELLE ST APT 2
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City | MORENO VALLEY
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State | CA
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Zip | 92551-4809
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Country | US
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Telephone | 951-207-5382
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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 | 129549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 129549
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License Number State | CA
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