Provider Demographics
NPI:1891993390
Name:GONZALEZ, LORI DAWN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:DAWN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:DAWN
Other - Last Name:AERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3124 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74110-2320
Mailing Address - Country:US
Mailing Address - Phone:918-508-2755
Mailing Address - Fax:918-744-4432
Practice Address - Street 1:3124 E APACHE ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2320
Practice Address - Country:US
Practice Address - Phone:918-508-2755
Practice Address - Fax:918-744-4432
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health