Provider Demographics
NPI:1891810925
Name:GONZALEZ, TERESA A (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FORDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5712
Mailing Address - Country:US
Mailing Address - Phone:209-573-0353
Mailing Address - Fax:
Practice Address - Street 1:1001 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0730
Practice Address - Country:US
Practice Address - Phone:209-573-0353
Practice Address - Fax:209-529-8519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143731101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator