Provider Demographics
NPI:1194902577
Name:GONZALES, RAYMOND NACHO (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:NACHO
Last Name:GONZALES
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93776-2107
Mailing Address - Country:US
Mailing Address - Phone:559-265-4800
Mailing Address - Fax:559-265-4823
Practice Address - Street 1:2772 MARTIN LUTHER KING BLVD.
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2107
Practice Address - Country:US
Practice Address - Phone:559-265-4800
Practice Address - Fax:559-265-4823
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC.A.T.C.#071459101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)