Provider Demographics
NPI:1093428492
Name:GOMES, LAWRENCE EUGENE II (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:GOMES
Suffix:II
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:EUGENE
Other - Last Name:GOMES
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:PEER SUPPORT SPECIAL
Mailing Address - Street 1:15657 N HAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1945
Mailing Address - Country:US
Mailing Address - Phone:480-601-7277
Mailing Address - Fax:
Practice Address - Street 1:10143 W PRESTON LN
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1271
Practice Address - Country:US
Practice Address - Phone:602-616-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty