Provider Demographics
NPI:1588707707
Name:GONZALEZ, THERESE MARIE (MS, MFT INTERN)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 LA SERNA DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2247
Mailing Address - Country:US
Mailing Address - Phone:562-698-7295
Mailing Address - Fax:
Practice Address - Street 1:934 N MOUNTAIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3659
Practice Address - Country:US
Practice Address - Phone:909-579-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF46175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist