MEDICARE: LILIANA GONZALEZ LMHC

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	MH10158	FL

General Provider Information

NPI Number	:	1861081614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA GONZALEZ LMHC

Provider Business Mailing Address
First Line	:	205 BAHIA PT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3500
Country	:	US
Telephone Number	:	239-398-0047
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 BAHIA PT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3500
Country	:	US
Telephone Number	:	239-398-0047
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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