Provider Demographics
NPI:1013699594
Name:GONZALEZ, ELICET (AMFT,)
Entity type:Individual
Prefix:MS
First Name:ELICET
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:AMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12571 BUARO ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5743
Mailing Address - Country:US
Mailing Address - Phone:949-698-2378
Mailing Address - Fax:
Practice Address - Street 1:2115 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2203
Practice Address - Country:US
Practice Address - Phone:323-938-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist