MEDICARE: OLIVIA GONZALES LMFTA

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
2	390200000X	Student in an Organized Health Care Education/Training Program
3	106H00000X	Marriage & Family Therapist	60956978	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316436959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA GONZALES LMFTA

Provider Business Mailing Address
First Line	:	1960 N HOLY NAMES CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5803
Country	:	US
Telephone Number	:	509-455-4968
Fax Number	:	509-455-4988

Provider Business Practice Location Address
First Line	:	1960 N HOLY NAMES CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5803
Country	:	US
Telephone Number	:	509-455-4968
Fax Number	:	509-455-4988

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	01/03/2020

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