Healthcare Provider Details

I. General information

NPI: 1982125381
Provider Name (Legal Business Name): GABRIEL ANDREW ANDERSON M.A.ED., LPCC, AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2684 RADIO LN
REDDING CA
96001-4232
US

IV. Provider business mailing address

25000 CENTER RIDGE RD STE 6
WESTLAKE OH
44145-4105
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-7352
  • Fax:
Mailing address:
  • Phone: 440-892-7034
  • Fax: 440-815-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.2102511
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: