Individual
MRS. LATRELLE MARIE GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4804 LACEY BLVD SE, LACEY, WA 98503-5733
(360) 799-5782
Mailing address
4804 LACEY BLVD SE, LACEY, WA 98503-5733
(360) 799-5782
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCC.CL.61231797
CERTIFICATION
—
Enumeration date
10/30/2021
Last updated
10/30/2021
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