Provider Demographics
NPI:1710328323
Name:GONZALEZ, RAUL K (LPCC)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:K
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 DAHLIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2470
Mailing Address - Country:US
Mailing Address - Phone:269-325-7275
Mailing Address - Fax:
Practice Address - Street 1:11920 DAHLIA AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2470
Practice Address - Country:US
Practice Address - Phone:269-325-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0200211101YM0800X
MI6401014052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37357841Medicaid