Provider Demographics
NPI:1700499381
Name:TABITHA GONZALEZ LICENSED MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:TABITHA GONZALEZ LICENSED MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-359-2887
Mailing Address - Street 1:100 S BEDFORD RD STE 340321
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3425
Mailing Address - Country:US
Mailing Address - Phone:646-359-2887
Mailing Address - Fax:
Practice Address - Street 1:100 S BEDFORD RD STE 340321
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3425
Practice Address - Country:US
Practice Address - Phone:646-359-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health