Provider Demographics
NPI:1457067530
Name:GONZALES, TATIANA PATRICIA (MHC)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:PATRICIA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 COLCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1667
Mailing Address - Country:US
Mailing Address - Phone:863-669-5989
Mailing Address - Fax:
Practice Address - Street 1:1455 GENE ST
Practice Address - Street 2:# A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:321-527-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2024-02-21
Deactivation Date:2023-10-27
Deactivation Code:
Reactivation Date:2024-02-21
Provider Licenses
StateLicense IDTaxonomies
FLIMH20523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health