Individual
IVANA ELISA BORBA GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAMFT
Contact information
Practice address
160 NW GILMAN BLVD STE 327, ISSAQUAH, WA 98027-2550
(425) 615-0860
Mailing address
2588 S 1000 W, NIBLEY, UT 84321-6545
(425) 615-0860
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
13575455-3904
UT
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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