Provider Demographics
NPI:1447558036
Name:GONZALEZ, JUAN CARLOS (LMFT)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 SW 87TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2535
Mailing Address - Country:US
Mailing Address - Phone:786-229-2614
Mailing Address - Fax:305-412-8447
Practice Address - Street 1:9075 SW 87TH AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2308
Practice Address - Country:US
Practice Address - Phone:786-229-2614
Practice Address - Fax:786-477-6010
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist