Healthcare Provider Details

I. General information

NPI: 1487079679
Provider Name (Legal Business Name): GABRIELA SUAREZ MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 CALIFORNIA AVE
LONG BEACH CA
90807-1507
US

IV. Provider business mailing address

878 W TOWN AND COUNTRY RD BLDG# 134
ORANGE CA
92868-4712
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-4762
  • Fax: 562-216-4767
Mailing address:
  • Phone: 714-954-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77346
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF77346
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: