Provider Demographics
NPI:1699154377
Name:GONZALEZ, BARBARA J (QMHP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11695 SW TEAL BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8081
Mailing Address - Country:US
Mailing Address - Phone:503-717-3231
Mailing Address - Fax:
Practice Address - Street 1:65 N HIGHWAY 101 STE 204
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-861-2043
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690706Medicaid