Provider Demographics
NPI:1639295090
Name:GONZALEZ, HAZEL BRAY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:BRAY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:215 BLACKFOOT LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4457
Mailing Address - Country:US
Mailing Address - Phone:805-889-0284
Mailing Address - Fax:805-889-0284
Practice Address - Street 1:215 BLACKFOOT LN
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4457
Practice Address - Country:US
Practice Address - Phone:805-889-0284
Practice Address - Fax:805-889-0284
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist