Healthcare Provider Details

I. General information

NPI: 1285720953
Provider Name (Legal Business Name): SARA LEGEMAN GAYL MS, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W OCEAN BLVD SUITE 18
LONG BEACH CA
90802-4605
US

IV. Provider business mailing address

319 PARSONS LNDG
LONG BEACH CA
90803-6814
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-0362
  • Fax: 714-893-3267
Mailing address:
  • Phone: 562-494-9711
  • Fax: 714-893-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMFC 32609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: