Healthcare Provider Details

I. General information

NPI: 1255435202
Provider Name (Legal Business Name): GWEN SANDERS MFT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3873 PIEDMONT AVE STE 3
OAKLAND CA
94611-5370
US

IV. Provider business mailing address

3873 PIEDMONT AVE STE 3
OAKLAND CA
94611-5370
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-3901
  • Fax:
Mailing address:
  • Phone: 510-869-3901
  • Fax: 510-317-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number33229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: