Organization
FAWN GONZALES LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAWN GONZALES (OWNER)
(541) 944-7711
Entity
Organization
Contact information
Practice address
14 COTTAGE ST, MEDFORD, OR 97504-7332
(541) 944-7711
Mailing address
1820 W BALBOA BLVD, NEWPORT BEACH, CA 92663-4515
(541) 944-7711
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5212
OR
Other
Enumeration date
12/04/2015
Last updated
12/04/2015
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