Provider Demographics
NPI:1164790143
Name:GONZALEZ, ELENA K (LMFT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:K
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:FAMILY SUCCESS
Other - Middle Name:
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2473 KARL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6511
Mailing Address - Country:US
Mailing Address - Phone:305-614-4751
Mailing Address - Fax:760-205-4866
Practice Address - Street 1:2473 KARL DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6511
Practice Address - Country:US
Practice Address - Phone:305-614-4751
Practice Address - Fax:760-205-4866
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97660OtherBOARD OF BEHAVIORAL SCIENCE