Provider Demographics
NPI:1194199810
Name:GONZALEZ, MICHAEL J (MACP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 NW 47TH AVE
Mailing Address - Street 2:HECTOR BUILDING (#2)
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1543
Mailing Address - Country:US
Mailing Address - Phone:305-430-0085
Mailing Address - Fax:305-474-1312
Practice Address - Street 1:20000 NW 47TH AVE
Practice Address - Street 2:HECTOR BUILDING (#2)
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1543
Practice Address - Country:US
Practice Address - Phone:305-430-0085
Practice Address - Fax:305-474-1312
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health