MEDICARE: JENNIFER GAY LMFT109700

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT109700	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114438538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GAY LMFT109700

Provider Business Mailing Address
First Line	:	PO BOX 340153
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-0153
Country	:	US
Telephone Number	:	530-312-4994
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 N COTTONWOOD ST STE 2500
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-6664
Country	:	US
Telephone Number	:	530-312-4994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/04/2022

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