Healthcare Provider Details

I. General information

NPI: 1962896654
Provider Name (Legal Business Name): DEBORAH TOBIAS GATEWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2788 SCOTT AVE
CLOVIS CA
93611-6975
US

IV. Provider business mailing address

2788 SCOTT AVE
CLOVIS CA
93611-6975
US

V. Phone/Fax

Practice location:
  • Phone: 559-731-7482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number47442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: