Provider Demographics
NPI:1174017677
Name:GONZALES, JORDAN ANTHONY (LMFT, ATR-P)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANTHONY
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LMFT, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20353 PARK WAY APT 44
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5324
Mailing Address - Country:US
Mailing Address - Phone:916-215-8068
Mailing Address - Fax:
Practice Address - Street 1:400 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3803
Practice Address - Country:US
Practice Address - Phone:650-839-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist