Active NPI
Anna Gonzales, LPCC
- School Psychologist
- Las Vegas, NM
National Provider Identifier
1720102874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1294
- Practice address
- 179 Bridge St
Las Vegas, NM 87701-3495 - Phone
- (505) 426-2554
- Fax
- (505) 426-2782
- NPI assigned
- Mar 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1294 | NM | Primary |
Addresses
Primary practice location
179 Bridge St
Las Vegas, NM 87701-3495
Mailing address
2026 N Gonzales St
Las Vegas, NM 87701-3452
Phone (505) 426-2706
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54789028 | Medicaid | NM |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1294 | NM | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720102874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2026 N GONZALES ST",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877013452",
"telephone_number": "505-426-2706",
"fax_number": "505-426-2782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 BRIDGE ST",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877013495",
"telephone_number": "505-426-2554",
"fax_number": "505-426-2782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "ANNA",
"name_prefix": "Ms.",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NM",
"license": "1294",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54789028",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.