Provider Demographics
NPI:1083370738
Name:GONZALEZ, MAHDEVI C (BA)
Entity Type:Individual
Prefix:
First Name:MAHDEVI
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N COUNTRY CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1650
Mailing Address - Country:US
Mailing Address - Phone:520-229-6220
Mailing Address - Fax:
Practice Address - Street 1:3131 N COUNTRY CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1650
Practice Address - Country:US
Practice Address - Phone:520-229-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIDKOtherUMR