Healthcare Provider Details

I. General information

NPI: 1114797990
Provider Name (Legal Business Name): GABRIEL BARBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GABE BARBER

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GATEWAY DR STE 210
LINCOLN CA
95648-3306
US

IV. Provider business mailing address

500 CROWN POINT CIR
GRASS VALLEY CA
95945-9561
US

V. Phone/Fax

Practice location:
  • Phone: 916-645-3300
  • Fax:
Mailing address:
  • Phone: 530-270-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT153161
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: