Provider Demographics
NPI:1518457332
Name:GONZALES, REBECCA LINDSEY (LAMFT, LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LINDSEY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LAMFT, LCPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LINDSEY
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190213
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0213
Mailing Address - Country:US
Mailing Address - Phone:208-614-0588
Mailing Address - Fax:
Practice Address - Street 1:6625 W HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2023
Practice Address - Country:US
Practice Address - Phone:208-614-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6890106H00000X
ID7522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist