Provider Demographics
NPI:1013396142
Name:GONZALES, CHRISTINE ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:CHEETHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT TRAINEE
Mailing Address - Street 1:11920 RAMONA BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-2314
Mailing Address - Country:US
Mailing Address - Phone:626-448-5501
Mailing Address - Fax:626-448-5502
Practice Address - Street 1:11920 RAMONA BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2314
Practice Address - Country:US
Practice Address - Phone:626-448-5501
Practice Address - Fax:626-448-5502
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist