Provider Demographics
NPI:1700209921
Name:GONZALEZ, ANN ELIZABETH (MA, MFA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, MFA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17962 MIDVALE AVE. N
Mailing Address - Street 2:#223
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-817-4794
Mailing Address - Fax:206-902-1322
Practice Address - Street 1:17962 MIDVALE AVE. N
Practice Address - Street 2:#223
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-817-4794
Practice Address - Fax:206-902-1322
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60439750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health