Provider Demographics
NPI:1316008816
Name:GONZALES, GLADYS (LMFT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 FENTON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4556
Mailing Address - Country:US
Mailing Address - Phone:619-763-0124
Mailing Address - Fax:619-566-4076
Practice Address - Street 1:2400 FENTON ST STE 210
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4556
Practice Address - Country:US
Practice Address - Phone:619-763-0124
Practice Address - Fax:619-566-4076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84386106H00000X
CAIMF 58848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316008816OtherMEDICAL INSURANCES