Healthcare Provider Details

I. General information

NPI: 1588825624
Provider Name (Legal Business Name): CYNTHIA L. GUM MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 FOREST AVE STE 2
PACIFIC GROVE CA
93950-4264
US

IV. Provider business mailing address

621 FOREST AVE STE 2
PACIFIC GROVE CA
93950-4264
US

V. Phone/Fax

Practice location:
  • Phone: 831-655-2188
  • Fax: 831-655-3092
Mailing address:
  • Phone: 831-655-2188
  • Fax: 831-655-3092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: