Provider Demographics
NPI:1093901852
Name:GONZALES, SHERLEY JUNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:SHERLEY
Middle Name:JUNE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:EDD
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 144
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-0144
Mailing Address - Country:US
Mailing Address - Phone:575-586-2404
Mailing Address - Fax:575-586-1549
Practice Address - Street 1:81 CABRESTO RD
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556
Practice Address - Country:US
Practice Address - Phone:575-586-2404
Practice Address - Fax:575-586-1549
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist