Provider Demographics
NPI:1598484354
Name:GONZALEZ, KRYSTAL A (BSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 S MARK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-9166
Mailing Address - Country:US
Mailing Address - Phone:520-272-3722
Mailing Address - Fax:
Practice Address - Street 1:1120 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7408
Practice Address - Country:US
Practice Address - Phone:520-624-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical