Individual
SELENA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCC, LPC
Contact information
Practice address
720 45TH ST, MUNSTER, IN 46321-2818
(219) 852-2515
(219) 852-2443
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004647A
IN
101YP2500X
Professional Counselor
178.016347
IL
Other
Enumeration date
10/22/2020
Last updated
01/04/2024
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