Provider Demographics
NPI:1508914177
Name:GONZALEZ-THRASH, IRIS (LCSW)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:GONZALEZ-THRASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:THRASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 TANGLEWOOD
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1821
Mailing Address - Country:US
Mailing Address - Phone:949-302-0421
Mailing Address - Fax:714-543-4431
Practice Address - Street 1:24800 CHRISANTA DR
Practice Address - Street 2:STE. 220
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4833
Practice Address - Country:US
Practice Address - Phone:949-302-0421
Practice Address - Fax:714-543-4431
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 199561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical