Provider Demographics
NPI:1770821878
Name:GONZALEZ, TERRY LYNN (MA MHP)
Entity Type:Individual
Prefix:MISS
First Name:TERRY
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA MHP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 TERRA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8621
Mailing Address - Country:US
Mailing Address - Phone:360-623-9750
Mailing Address - Fax:
Practice Address - Street 1:921 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2316
Practice Address - Country:US
Practice Address - Phone:360-423-0203
Practice Address - Fax:360-423-2311
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health