Individual
JACOB GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
800 S WALNUT ST, LAS CRUCES, NM 88001-3954
(575) 526-2819
Mailing address
1425 WYOMING AVE APT 4, LAS CRUCES, NM 88001-5759
(915) 777-9023
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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