Provider Demographics
NPI:1033319157
Name:GONZALEZ, ULISES (LPC)
Entity Type:Individual
Prefix:
First Name:ULISES
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-0095
Mailing Address - Country:US
Mailing Address - Phone:623-628-8788
Mailing Address - Fax:623-466-6127
Practice Address - Street 1:1300 N MILLER RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1000
Practice Address - Country:US
Practice Address - Phone:623-628-8788
Practice Address - Fax:623-466-6127
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14052101YP2500X
AZ10260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ14052OtherLPC
AZ10260OtherLAMFT