Provider Demographics
NPI:1538879465
Name:CARO GONZALEZ, JULIAN DAVID SR (AAC)
Entity type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:DAVID
Last Name:CARO GONZALEZ
Suffix:SR
Gender:M
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7803 NE FOURTH PLAIN BLVD STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7294
Practice Address - Country:US
Practice Address - Phone:360-566-4432
Practice Address - Fax:360-695-0628
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61352992101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health