Provider Demographics
NPI:1942732276
Name:GONZALEZ, CONNIE SUGUEY
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUGUEY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 RANGER RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7630
Mailing Address - Country:US
Mailing Address - Phone:775-221-4149
Mailing Address - Fax:
Practice Address - Street 1:1480 RANGER RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-7630
Practice Address - Country:US
Practice Address - Phone:775-221-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV600002002103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst