Provider Demographics
NPI:1447071451
Name:GONZALES, TIMOTHY JORGE
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JORGE
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 INGLENOOK LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5126
Mailing Address - Country:US
Mailing Address - Phone:224-616-9460
Mailing Address - Fax:
Practice Address - Street 1:550 W FRONTAGE RD STE 3825
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1262
Practice Address - Country:US
Practice Address - Phone:847-821-9346
Practice Address - Fax:847-821-0545
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020754101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor