Provider Demographics
NPI:1275037830
Name:GONZALEZ, NICOLE (LCMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5097 W CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9743
Mailing Address - Country:US
Mailing Address - Phone:857-825-0563
Mailing Address - Fax:
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:785-587-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03094106H00000X
KS2950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist