Mark Gonzales, LAADC-CA LCI10970318

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCI10970318 Issued in CA

Practice address

4023 W Douglas Ave
Visalia, CA 93291-4185

Phone

(510) 691-0474

NPI assigned

Nov 4, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sun Prevention Treatment & Recovery LLC

  • Community/Behavioral Health Agency
  • Visalia, CA
  • NPI 1275038879
  NPD Authorized official

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1619306289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4023 W DOUGLAS AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932914185",
            "telephone_number": "510-691-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4023 W DOUGLAS AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932914185",
            "telephone_number": "510-691-0474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 Tennessee St",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945904453",
            "country_code": "US",
            "telephone_number": "707-554-2397 x109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4023 W Douglas Ave",
            "address_purpose": "LOCATION",
            "city": "Visalia",
            "state": "CA",
            "postal_code": "932914185",
            "country_code": "US",
            "telephone_number": "510-691-0474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "MARK",
        "credential": "LAADC-CA LCI10970318",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2023-03-07",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "5465630291",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "LCI10970318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADDICTION COUNSELOR CERTIFICATION BOARD OF CALIFORNIA",
            "identifier": "168767",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erik James Gonzales
• Julieann Gonzales, NP
• Kylie Noel Gonzales
• Lynn Whitlatch Gonzales, LCSW
• Madison Gonzales
• Noelle Gonzales
• Stephanie Gonzales
• Sumer D Gonzales, RN
• Mariana Gonzalez Torres
• Aaliyah Reyes Gonzalez

• Addiction (Substance Use Disorder) Counselor in Visalia, CA
• Providers in Visalia, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.