Healthcare Provider Details

I. General information

NPI: 1699708404
Provider Name (Legal Business Name): GAIL SUE EISELMAN L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

49 PARK WAY
PIEDMONT CA
94611-3928
US

IV. Provider business mailing address

49 PARK WAY
PIEDMONT CA
94611-3928
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-6111
  • Fax: 510-653-7267
Mailing address:
  • Phone: 510-653-6111
  • Fax: 510-653-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC18300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: