Provider Demographics
NPI:1467661066
Name:GONZALES, LORI (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:GONZALES
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 1:900 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2037
Mailing Address - Country:US
Mailing Address - Phone:316-283-1950
Mailing Address - Fax:316-283-9540
Practice Address - Street 1:4505 E 47TH ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1651
Practice Address - Country:US
Practice Address - Phone:316-529-9100
Practice Address - Fax:316-529-9351
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist