MEDICARE: AALYSHA MICHELLE GONZALEZ LMHC, LPC

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	4146	OK
2	101YM0800X	Mental Health Counselor	MH9697	FL

General Provider Information

NPI Number	:	1962631945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AALYSHA MICHELLE GONZALEZ LMHC, LPC

Provider Business Mailing Address
First Line	:	5960 SNOWDROP WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-4511
Country	:	US
Telephone Number	:	918-740-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 SNOWDROP WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-4511
Country	:	US
Telephone Number	:	918-740-0393
Fax Number	:

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

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/18/2011

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