MEDICARE: MARIANN GONZALEZ ACMHC

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	10434636-6009	UT

General Provider Information

NPI Number	:	1457286056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANN GONZALEZ ACMHC

Provider Business Mailing Address
First Line	:	1422 E 820 N
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-5481
Country	:	US
Telephone Number	:	385-309-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	10718 S BECKSTEAD LN STE 103
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-2605
Country	:	US
Telephone Number	:	385-309-1038
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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