Provider Demographics
NPI:1568817591
Name:GONZALEZ-VALENTINO, OMAR (MS, LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:GONZALEZ-VALENTINO
Suffix:
Gender:M
Credentials:MS, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 VONNIE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1413
Mailing Address - Country:US
Mailing Address - Phone:951-394-2363
Mailing Address - Fax:
Practice Address - Street 1:4175 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3442
Practice Address - Country:US
Practice Address - Phone:951-965-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6913101YP2500X
CA115094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional