Provider Demographics
NPI:1518418037
Name:GONZALEZ, MARCELO (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARCELO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 N PAULINA ST
Mailing Address - Street 2:206 F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1068
Mailing Address - Country:US
Mailing Address - Phone:786-348-9097
Mailing Address - Fax:
Practice Address - Street 1:3354 N PAULINA ST
Practice Address - Street 2:206F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1068
Practice Address - Country:US
Practice Address - Phone:773-828-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional