Provider Demographics
NPI:1699346916
Name:GONZALES, JODY CHRISTOPHER (CSW)
Entity type:Individual
Prefix:MR
First Name:JODY
Middle Name:CHRISTOPHER
Last Name:GONZALES
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-0392
Mailing Address - Country:US
Mailing Address - Phone:575-461-9907
Mailing Address - Fax:575-403-9867
Practice Address - Street 1:419 S 2ND ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2859
Practice Address - Country:US
Practice Address - Phone:575-461-9907
Practice Address - Fax:575-403-9867
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor