Provider Demographics
NPI:1538440847
Name:GONZALEZ, JINELL NELLIE (LMHC,BCBA)
Entity type:Individual
Prefix:MRS
First Name:JINELL
Middle Name:NELLIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMHC,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15250 SW 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-5437
Mailing Address - Country:US
Mailing Address - Phone:305-788-2491
Mailing Address - Fax:
Practice Address - Street 1:12485 SW 137TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4217
Practice Address - Country:US
Practice Address - Phone:305-788-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12161101YM0800X
FL1-21-55809103K00000X
FLIMH9171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health