Provider Demographics
NPI:1528207354
Name:GONZALEZ, ANA I (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:I
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 1:2524 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3406
Mailing Address - Country:US
Mailing Address - Phone:773-843-9139
Mailing Address - Fax:
Practice Address - Street 1:2733 W 23RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3601
Practice Address - Country:US
Practice Address - Phone:773-843-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional