Provider Demographics
NPI:1710102090
Name:GONZALES, GREGORY LEE (MS, LPCC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MONTANA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-4294
Mailing Address - Country:US
Mailing Address - Phone:575-202-7047
Mailing Address - Fax:575-647-8050
Practice Address - Street 1:650 MONTANA AVE STE E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4294
Practice Address - Country:US
Practice Address - Phone:575-202-7047
Practice Address - Fax:575-647-8050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health