Provider Demographics
NPI:1467883082
Name:GONZALEZ, ELENA PAULA GURROLA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:PAULA GURROLA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:PAULA
Other - Last Name:GURROLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3605 VISTA WAY STE 258
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4565
Mailing Address - Country:US
Mailing Address - Phone:760-758-1480
Mailing Address - Fax:760-435-9472
Practice Address - Street 1:3605 VISTA WAY STE 258
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4565
Practice Address - Country:US
Practice Address - Phone:760-758-1480
Practice Address - Fax:760-435-9472
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85254106H00000X
390200000X
CALMFT104665106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program