Provider Demographics
NPI:1861638298
Name:GONZALEZ, BONNIE JO (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 234TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4746
Mailing Address - Country:US
Mailing Address - Phone:425-213-3041
Mailing Address - Fax:425-670-2526
Practice Address - Street 1:5508 234TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4746
Practice Address - Country:US
Practice Address - Phone:425-213-3041
Practice Address - Fax:425-670-2526
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60161889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist