Provider Demographics
NPI:1497088868
Name:GONZALES, KELLY HERZSTEIN
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HERZSTEIN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 N 1ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2986
Mailing Address - Country:US
Mailing Address - Phone:559-221-8100
Mailing Address - Fax:559-221-8101
Practice Address - Street 1:7225 N 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2986
Practice Address - Country:US
Practice Address - Phone:559-221-8101
Practice Address - Fax:559-221-8101
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor