MEDICARE: GISSEL BLANCA GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114557527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISSEL BLANCA GONZALEZ

Provider Business Mailing Address
First Line	:	77 S ADAMS ST APT 604
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2917
Country	:	US
Telephone Number	:	406-210-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 S ADAMS ST APT 604
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2917
Country	:	US
Telephone Number	:	406-210-7521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	01/24/2020

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