Provider Demographics
NPI:1629185038
Name:GONZALEZ-FORESTIER, TOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:GONZALEZ-FORESTIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W PLEASANT ST
Mailing Address - Street 2:116B
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3399
Mailing Address - Country:US
Mailing Address - Phone:641-842-3101
Mailing Address - Fax:
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:116B
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3399
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00219OtherHSP IN PSYCHOLOGY
IA00469OtherPSYCHOLOGY LICENSE