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General NPI Number Information
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NPI Number | 1346923307
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Entity Type | Organization
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Legal Business Name | JEANPAULO A. GONZALEZ, LICENSED CLINICAL SOCIAL WORKER INC.
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 101 E REDLANDS BLVD STE 234A
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City | REDLANDS
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State | CA
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Zip | 92373-4775
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Country | US
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Telephone | 909-264-1388
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E REDLANDS BLVD STE 234A
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City | REDLANDS
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State | CA
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Zip | 92373-4775
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Country | US
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Telephone | 909-264-1388
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST/CEO
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Name | MR. JEANPAULO ALFONSO GONZALEZ
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Credential | LCSW
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Telephone | 909-264-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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