Provider Demographics
NPI:1386903094
Name:GONZALES, ALEXIS ARIANA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ARIANA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ARIANA
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1521 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1422
Mailing Address - Country:US
Mailing Address - Phone:510-644-6251
Mailing Address - Fax:510-644-2887
Practice Address - Street 1:1521 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1422
Practice Address - Country:US
Practice Address - Phone:510-644-6251
Practice Address - Fax:510-644-2887
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA113870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health