Individual
LISA GAIL GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LMHC
Contact information
Practice address
202 CENTRAL AVE SE, ALBUQUERQUE, NM 87102-3460
(505) 268-1124
Mailing address
2551 COORS BLVD NW, ALBUQUERQUE, NM 87120-1213
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0138111
NM
101YM0800X
Mental Health Counselor
T-0134721
NM
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
06/04/2010
Last updated
07/07/2014
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