Kellie Lynn Gonzalez, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

92986 Issued in CA

Practice address

525 Technology CT Ste 105
Riverside, CA 92507-2181

Phone

(951) 686-8500

NPI assigned

Apr 19, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD
• Olive Crest

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1215418165
  NPD (past)
• Recovery Innovations, Inc

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1902776107
  NPD (past)

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1730742263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 E PALM CANYON DR STE 110",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922641623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 TECHNOLOGY CT STE 105",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072181",
            "telephone_number": "951-686-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N Palm Canyon Dr Ste A4",
            "address_purpose": "LOCATION",
            "city": "Palm Springs",
            "state": "CA",
            "postal_code": "922621866",
            "country_code": "US",
            "telephone_number": "442-268-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2608 Victor Ave",
            "address_purpose": "LOCATION",
            "city": "Redding",
            "state": "CA",
            "postal_code": "960021447",
            "country_code": "US",
            "telephone_number": "530-722-1022",
            "fax_number": "530-722-1058",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "590 Antelope Blvd Ste 40B",
            "address_purpose": "LOCATION",
            "city": "Red Bluff",
            "state": "CA",
            "postal_code": "960802477",
            "country_code": "US",
            "telephone_number": "530-529-9454 x119",
            "fax_number": "530-529-9456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "KELLIE",
        "middle_name": "LYNN",
        "credential": "AMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-19",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "92986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "D3043190",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbobadilla@childrenfirstffa.com",
            "affiliation": "N",
            "endpointDescription": "Administrative Assistant",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "590 Antelope Blvd Ste 40B",
            "city": "Red Bluff",
            "state": "CA",
            "country_code": "US",
            "postal_code": "960802477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Johan Gonzalez
• John B Gonzalez, MD
• Jonathan Gonzalez, M.A.
• Jose B Gonzalez, LCSW
• Joseph Gonzalez
• Laura Gonzalez
• Lauren Nicole Gonzalez
• Leah Gonzalez
• Leeana Gonzalez
• Leslie Maria Gonzalez

• Marriage & Family Therapist in Riverside, CA
• Providers in Riverside, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.