MEDICARE: KIERSTEN 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		AZ

General Provider Information

NPI Number	:	1255281945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERSTEN GONZALEZ

Provider Business Mailing Address
First Line	:	4901 N TONTO WAY
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-5273
Country	:	US
Telephone Number	:	805-290-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 N TONTO WAY
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-5273
Country	:	US
Telephone Number	:	805-290-5498
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ KIERSTEN GONZALEZ ” Practice Location

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