Audrey Gonzalez, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.012116 Issued in IL

Practice address

807 W Highway 50 Ste 3
O Fallon, IL 62269-1856

Phone

(618) 468-8069

Fax

(619) 202-2160

NPI assigned

Mar 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Audrey Wartsbaugh Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Untangled Minds PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • O Fallon, IL
  • NPI 1952022527
  NPD Authorized official

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1437610086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 W HIGHWAY 50 STE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691856",
            "telephone_number": "618-468-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 W HIGHWAY 50 STE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691856",
            "telephone_number": "618-468-8069",
            "fax_number": "619-202-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "AUDREY",
        "name_prefix": "Mrs.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.012116",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2021046000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF PROFESSIONAL REGULATION",
            "identifier": "2021046000",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF PROFESSIONAL REGULATION",
            "identifier": "180.012116",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "WARTSBAUGH",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephanie Lynn Gillette, BEHAVIOR TECHNICIAN
• Angela Waleska Giron Bonilla
• Global Medical Solutionz Equipment & Transportation
• Barbara Glotfelty
• Alexandria Gomez, PHARMD
• Malcolm Noyes Goodwin Jr., M. D.
• Kamron Kingsley Gopffarth, DO
• Bryon John Gorton, M.D.
• Raghav Govindarajan, MD
• Catherin Teiarra Graham

• Professional Counselor in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.