Provider Demographics
NPI:1114268026
Name:GONZALEZ, EDUARDO WILFREDO (LMHC)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:WILFREDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OSCEOLA ST STE 113
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7800
Mailing Address - Country:US
Mailing Address - Phone:321-320-3782
Mailing Address - Fax:386-218-0632
Practice Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:212
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7270
Practice Address - Country:US
Practice Address - Phone:800-840-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH16841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH11391OtherREGISTERED MENTAL HEALTH COUNSELOR INTERN
FLIMH11391OtherREGISTERED MENTAL HEALTH COUNSELOR INTERN