Provider Demographics
NPI:1740423078
Name:GONZALEZ, ALEX C (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S OREM BLVD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-3101
Mailing Address - Country:US
Mailing Address - Phone:801-921-5932
Mailing Address - Fax:801-224-0508
Practice Address - Street 1:519 S OREM BLVD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-3101
Practice Address - Country:US
Practice Address - Phone:801-783-9292
Practice Address - Fax:801-224-0508
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58906136004101YP2500X
UT5890613-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional