Provider Demographics
NPI:1962835249
Name:GONZALES, HOLLY-MARIE CLARA (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY-MARIE
Middle Name:CLARA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 SW MULTNOMAH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3272
Mailing Address - Country:US
Mailing Address - Phone:303-328-1611
Mailing Address - Fax:
Practice Address - Street 1:1235 SE MORRISON ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2462
Practice Address - Country:US
Practice Address - Phone:503-376-7114
Practice Address - Fax:503-765-1896
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health