Individual provider Active NPI

Melissa Luke Gonzalez, PH.D.

  • Intellectual & Developmental Disabilities Psychologist
  • Chattanooga, TN
National Provider Identifier
1447563044
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
License
1430 Issued in LA
Practice address
1101 Carter St
Chattanooga, TN 37402-5017
Phone
(423) 490-7710
Fax
(423) 490-7750
NPI assigned
Jul 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual & Developmental Disabilities Psychologist 103TM1800X 04898 MD
Intellectual & Developmental Disabilities Psychologist 103TM1800X 1430 LA Primary

Addresses

Primary practice location

1101 Carter St
Chattanooga, TN 37402-5017

Mailing address

1101 Carter St
Chattanooga, TN 37402-5017
Phone (423) 490-7710

Other practice location 1

707 N Broadway
Baltimore, MD 21205-1832
Phone (443) 923-2817

Other practice location 2

8415 Goodwood Blvd Ste 200
Baton Rouge, LA 70806-7851
Phone (225) 765-6346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
04898MDMDIntellectual & Developmental Disabilities Psychologist
1430LAMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1447563044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CARTER ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374025017",
            "telephone_number": "423-490-7710",
            "fax_number": "423-490-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CARTER ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374025017",
            "telephone_number": "423-490-7710",
            "fax_number": "423-490-7750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212051832",
            "country_code": "US",
            "telephone_number": "443-923-2817",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8415 Goodwood Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708067851",
            "country_code": "US",
            "telephone_number": "225-765-6346",
            "fax_number": "225-765-8585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MELISSA",
        "middle_name": "LUKE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-23",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MD",
            "license": "04898",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "LA",
            "license": "1430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; 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.