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NPI Code Detail

MEDICARE: JESSICA PATRICIA GONZALEZ

MEDICARE: JESSICA PATRICIA 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
1101YM0800XMental Health CounselorLH61380444WA
2101YP2500XProfessional CounselorTPMC7870FL
3101YP2500XProfessional Counselor0021607CO
4101YP2500XProfessional Counselor0021607TX
5101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1255988242
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PATRICIA GONZALEZ
Provider Business Mailing Address
First Line : 518 S 7TH ST APT 216
Second Line :
City : TACOMA
State : WA
Zip : 98402-2213
Country : US
Telephone Number : 719-209-5723
Fax Number :
Provider Business Practice Location Address
First Line : 5915 ORCHARD ST W
Second Line :
City : TACOMA
State : WA
Zip : 98467-3824
Country : US
Telephone Number : 253-414-7461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2019
Last Update Date : 06/03/2026

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Directions to “ JESSICA PATRICIA GONZALEZ ” Practice Location

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