Provider Demographics
NPI:1285123737
Name:GONZALEZ, VINCENT LOUIS (AA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:LOUIS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:AA PSYCHOLOGY
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:LOUIS
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3531 NW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5608
Mailing Address - Country:US
Mailing Address - Phone:405-760-8292
Mailing Address - Fax:
Practice Address - Street 1:4300 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5107
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker