Provider Demographics
NPI:1740423607
Name:LAURA GONZALES, M.A., L.P.C., N.C.C., P.L.L.C.
Entity Type:Organization
Organization Name:LAURA GONZALES, M.A., L.P.C., N.C.C., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:GENEVA
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, IMH-E
Authorized Official - Phone:602-327-0834
Mailing Address - Street 1:34108 N 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5070
Mailing Address - Country:US
Mailing Address - Phone:602-717-7213
Mailing Address - Fax:623-566-2062
Practice Address - Street 1:8715 W UNION HILLS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3029
Practice Address - Country:US
Practice Address - Phone:602-717-7213
Practice Address - Fax:623-566-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13196101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty