Provider Demographics
NPI:1639576911
Name:GONZALEZ, APOLLO
Entity Type:Individual
Prefix:
First Name:APOLLO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N GLENOAKS DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1601
Mailing Address - Country:US
Mailing Address - Phone:806-584-6944
Mailing Address - Fax:405-601-2023
Practice Address - Street 1:3001 N GLENOAKS DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1601
Practice Address - Country:US
Practice Address - Phone:806-584-6944
Practice Address - Fax:405-601-2023
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1398101YA0400X
305S00000X, 374K00000X, 170300000X, 175F00000X, 225400000X, 101YA0400X, 104100000X
TX225C00000X
OK10778101YM0800X
OK101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No305S00000XManaged Care OrganizationsPoint of Service
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No170300000XOther Service ProvidersGenetic Counselor, MS
No175F00000XOther Service ProvidersNaturopath
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker