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General NPI Number Information
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NPI Number | 1518515519
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Entity Type | Individual
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Provider Name | NYDIA IRIS GONZALEZ LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 1116 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60651-4152
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Country | US
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Telephone | 773-772-8009
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Fax | 773-292-5490
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Provider Business Mailing Address
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Address Line | 7936 W GRAND AVE APT 3E
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City | CHICAGO
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State | IL
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Zip | 60707-2346
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Country | US
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Telephone | 773-593-1822
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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 | 180010816
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License Number State | IL
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