Provider Demographics
NPI:1477894301
Name:GONZALEZ, JOSE II (LLPC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GONZALEZ
Suffix:II
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1757
Mailing Address - Country:US
Mailing Address - Phone:269-985-8804
Mailing Address - Fax:
Practice Address - Street 1:640 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1603
Practice Address - Country:US
Practice Address - Phone:269-471-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013061101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor