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General NPI Number Information
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NPI Number | 1932650785
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Entity Type | Individual
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Provider Name | GRACE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 201 HUNT ST APT 1622
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City | CLERMONT
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State | FL
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Zip | 34711-2484
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Country | US
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Telephone | 787-633-7208
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HUNT ST APT 1622
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City | CLERMONT
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State | FL
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Zip | 34711-2484
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Country | US
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Telephone | 787-633-7208
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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 |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | G524300767460
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License Number State | FL
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