Provider Demographics
NPI:1346323102
Name:GONZALEZ, JUDITH R (PSY D)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 S HAZEL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2870
Mailing Address - Country:US
Mailing Address - Phone:417-887-8707
Mailing Address - Fax:417-887-8706
Practice Address - Street 1:1436 W HOVEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-1509
Practice Address - Country:US
Practice Address - Phone:417-576-3621
Practice Address - Fax:417-887-8706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029906103TC0700X
MO200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist