Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-15788 | CO |
NPI | 1013318906 |
---|---|
Provider Name | Michele Gonzales |
First Address | Grand Junction, CO 81507-1026 |
Second Address | Grand Junction, CO 81507-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 05/12/2016 |