Individual
JESUS GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 NE 68TH AVE, PORTLAND, OR 97213-4957
(503) 988-8984
Mailing address
1401 NE 68TH AVE, PORTLAND, OR 97213-4957
(503) 988-8984
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/19/2016
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