Provider Demographics
NPI:1063261311
Name:DR. TINA GONZALES, PLLC
Entity type:Organization
Organization Name:DR. TINA GONZALES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-584-0621
Mailing Address - Street 1:300 WELSH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2248
Mailing Address - Country:US
Mailing Address - Phone:215-584-0621
Mailing Address - Fax:267-818-7048
Practice Address - Street 1:300 WELSH RD STE 100
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2248
Practice Address - Country:US
Practice Address - Phone:215-584-0621
Practice Address - Fax:267-818-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty