Provider Demographics
NPI:1154156305
Name:GONZALEZ, JESSICA MELISSA (RMHCI, RMFTI)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MELISSA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RMHCI, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13104 AUBREY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6536
Mailing Address - Country:US
Mailing Address - Phone:407-504-9196
Mailing Address - Fax:
Practice Address - Street 1:21 COLUMBIA ST STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1133
Practice Address - Country:US
Practice Address - Phone:321-841-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4153106H00000X
FLIMH25889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health