Healthcare Provider Details

I. General information

NPI: 1164868337
Provider Name (Legal Business Name): GAIL A. BUELOW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 100
SACRAMENTO CA
95825-6533
US

IV. Provider business mailing address

333 UNIVERSITY AVE STE 100
SACRAMENTO CA
95825-6533
US

V. Phone/Fax

Practice location:
  • Phone: 916-920-0877
  • Fax: 916-920-1931
Mailing address:
  • Phone: 916-920-0877
  • Fax: 916-920-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: