Provider Demographics
NPI:1871764167
Name:GONZALEZ, JAQUELINE (LMFT)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 NW 120TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4535
Mailing Address - Country:US
Mailing Address - Phone:954-227-9500
Mailing Address - Fax:954-344-2417
Practice Address - Street 1:7661 NW 120TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4535
Practice Address - Country:US
Practice Address - Phone:954-663-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2070106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist