Provider Demographics
NPI:1699187617
Name:GONZALEZ, MARCELLA MARIE (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4455 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2415
Mailing Address - Country:US
Mailing Address - Phone:303-512-8811
Mailing Address - Fax:
Practice Address - Street 1:4455 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-512-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-25
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional