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Individual

MICHAEL GONZALES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948
(541) 726-1465
Mailing address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
Primary
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500679-999
OR
Enumeration date
12/14/2015
Last updated
03/14/2019
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