Janice C Gonzales, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY4196 Issued in CO

Practice address

805 Desert Flower Blvd
Pueblo, CO 81001-1146

Phone

(719) 540-2183

NPI assigned

Jan 16, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442
  Medicare reassignment NPD
• Family Support Center of Colorado, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Colorado Springs, CO
  • NPI 1134733512

  Psychologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1215567425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 DESERT FLOWER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 DESERT FLOWER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011146",
            "telephone_number": "719-540-2183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Desert Flower Blvd",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810011146",
            "country_code": "US",
            "telephone_number": "562-857-5037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "JANICE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-16",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CO",
            "license": "0004196",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY4196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaycob Gonzales-Cordova
• Barbara A Gonzales, OWNER
• Felicia Gonzales, COTA
• Hope Gonzales
• James J Gonzales
• La Fon Ellen Gonzales, RN
• Nanci Gonzales
• Renae Gonzales
• Selena Lea Gonzales, COTA
• Sian Gonzales

• Clinical Psychologist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.