Provider Demographics
NPI:1144427774
Name:GONZALES, PAOLA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:PAOLA
Other - Middle Name:
Other - Last Name:MACHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:8291 UTICA AVE OFC 212
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7614
Mailing Address - Country:US
Mailing Address - Phone:909-278-7866
Mailing Address - Fax:
Practice Address - Street 1:8291 UTICA AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7614
Practice Address - Country:US
Practice Address - Phone:909-278-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 172V00000X
CA73310106H00000X
CA117160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker