Provider Demographics
NPI:1205309465
Name:GONZALEZ, INDIA ABIGAIL (MFT)
Entity type:Individual
Prefix:MRS
First Name:INDIA
Middle Name:ABIGAIL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8598 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2143
Mailing Address - Country:US
Mailing Address - Phone:805-217-5932
Mailing Address - Fax:
Practice Address - Street 1:8598 EUREKA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2143
Practice Address - Country:US
Practice Address - Phone:805-217-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE