Individual
BETTY LOU GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 327-4796
Mailing address
2300 RIDGECREST DR, FARMINGTON, NM 87401-3408
(505) 402-6626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
08/09/2017
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