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General NPI Number Information
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NPI Number | 1487972576
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Entity Type | Individual
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Provider Name | LAURA GENEVA GONZALES MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 8715 W. UNION HILLS SUITE 105
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City | PEORIA
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State | AZ
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Zip | 85382-7177
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Country | US
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Telephone | 602-717-7213
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Fax | 623-566-2062
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Provider Business Mailing Address
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Address Line | 34108 N. 26TH AVENUE
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City | PHOENIX
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State | AZ
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Zip | 85085-5070
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Country | US
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Telephone | 602-717-7213
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Fax | 623-566-2062
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC13196
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License Number State | AZ
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