Provider Demographics
NPI:1326935255
Name:GONZALEZ, EDITH GISSELLE (RMHCI)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:GISSELLE
Last Name:GONZALEZ
Suffix:
Gender:X
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 NW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5814
Mailing Address - Country:US
Mailing Address - Phone:305-512-3646
Mailing Address - Fax:
Practice Address - Street 1:1401 SW 1ST ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2261
Practice Address - Country:US
Practice Address - Phone:786-361-7787
Practice Address - Fax:305-902-3885
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health