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1417322231
FAWN GONZALES LCSW LLC
MEDFORD, OR
NPI
1417322231
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Entity Type
Organization
Authorized Contact
FAWN GONZALES
Owner
541-944-7711
Organization Subpart ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: OR 5212)
Enumeration Date
2015-12-04
Last Update Date
2015-12-04
Business Address
FAWN GONZALES LCSW LLC
14 COTTAGE ST
MEDFORD, OR 97504-7332
Phone number: 541-944-7711
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Mailing Address
FAWN GONZALES LCSW LLC
1820 W BALBOA BLVD
NEWPORT BEACH, CA 92663-4515
Phone number: 541-944-7711
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