Provider Demographics
NPI:1669845905
Name:GONZALES, JOAQUIN EDWARD (LMFT 141138)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:EDWARD
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LMFT 141138
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E DAKOTA AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4821
Mailing Address - Country:US
Mailing Address - Phone:559-216-1075
Mailing Address - Fax:
Practice Address - Street 1:1925 E DAKOTA AVE STE Q
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4821
Practice Address - Country:US
Practice Address - Phone:559-353-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112432IV101YA0400X
CALMFT141138106H00000X
CAAMFT122397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)