Provider Demographics
NPI:1114557527
Name:GONZALEZ, GISSEL BLANCA
Entity Type:Individual
Prefix:
First Name:GISSEL
Middle Name:BLANCA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S ADAMS ST APT 604
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2917
Mailing Address - Country:US
Mailing Address - Phone:406-210-7521
Mailing Address - Fax:
Practice Address - Street 1:77 S ADAMS ST APT 604
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2917
Practice Address - Country:US
Practice Address - Phone:406-210-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health