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Individual

JOHNNY DEAN GONZALES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BS

Contact information

Practice address
10180 SE SUNNYSIDE RD, 1ST FLOOR, WING A, CLACKAMAS, OR 97015-8970
(503) 571-0884
(503) 571-0866
Mailing address
10180 SE SUNNYSIDE RD, 1ST FLOOR, WING A, CLACKAMAS, OR 97015-8970
(503) 571-0884
(503) 571-0866

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
103TA0400X
OR

Other

Enumeration date
03/21/2012
Last updated
03/21/2012
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