Provider Demographics
NPI:1518327246
Name:GONZALEZ, NIEVES DEL CARMEN (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:NIEVES
Middle Name:DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-0812
Mailing Address - Country:US
Mailing Address - Phone:406-361-0444
Mailing Address - Fax:406-273-4707
Practice Address - Street 1:9801 VALLEY GROVE DR
Practice Address - Street 2:SUITE D
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8617
Practice Address - Country:US
Practice Address - Phone:406-273-4633
Practice Address - Fax:406-273-4707
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15791101YP2500X
WY1640101YP2500X
MTBBH-LCPC-LIC-15791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional