Provider Demographics
NPI:1255481495
Name:GONZALES, HUGO L (MFT)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HILLTOP MALL RD
Mailing Address - Street 2:SUITE 03
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1921
Mailing Address - Country:US
Mailing Address - Phone:510-375-0813
Mailing Address - Fax:510-758-4143
Practice Address - Street 1:3150 HILLTOP MALL RD
Practice Address - Street 2:SUITE 03
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1921
Practice Address - Country:US
Practice Address - Phone:510-375-0813
Practice Address - Fax:510-758-4143
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist