Provider Demographics
NPI:1124519095
Name:GONZALEZ, MARTHA ELENA (LMFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 E SANTA ANA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3943
Mailing Address - Country:US
Mailing Address - Phone:714-495-1626
Mailing Address - Fax:
Practice Address - Street 1:11351 DALE ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1545
Practice Address - Country:US
Practice Address - Phone:714-495-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130100488101YS0200X
CA104628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104628OtherLICENSED MARRIAGE AND FAMILY THERAPIST