Provider Demographics
NPI:1861296154
Name:GONZALES, NICHOLAS ALBERT (LMSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALBERT
Last Name:GONZALES
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 E CALVADA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-3994
Mailing Address - Country:US
Mailing Address - Phone:559-289-2886
Mailing Address - Fax:
Practice Address - Street 1:2360 E CALVADA BLVD STE D
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3994
Practice Address - Country:US
Practice Address - Phone:559-289-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11932-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker