Provider Demographics
NPI:1164071841
Name:GONZALEZ, GEORGANA MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGANA
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 W 900 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5526
Mailing Address - Country:US
Mailing Address - Phone:785-418-5951
Mailing Address - Fax:
Practice Address - Street 1:376 E 400 S STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1987
Practice Address - Country:US
Practice Address - Phone:385-364-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12324077-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical