Provider Demographics
NPI:1487719233
Name:GONZALEZ MUNOZ, LOURDES (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:GONZALEZ MUNOZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:12800 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4717
Mailing Address - Country:US
Mailing Address - Phone:786-399-6174
Mailing Address - Fax:
Practice Address - Street 1:7600 S RED RD
Practice Address - Street 2:SUITE 229
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-669-4455
Practice Address - Fax:305-665-5899
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7526101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health