MEDICARE: MS. GAIL A. BUELOW INTERN

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	101YM0800X	Mental Health Counselor	136101	CA

General Provider Information

NPI Number	:	1164868337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL A. BUELOW INTERN

Provider Business Mailing Address
First Line	:	333 UNIVERSITY AVE STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6533
Country	:	US
Telephone Number	:	916-920-0877
Fax Number	:	916-920-1931

Provider Business Practice Location Address
First Line	:	333 UNIVERSITY AVE STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6533
Country	:	US
Telephone Number	:	916-920-0877
Fax Number	:	916-920-1931

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/27/2026

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