Healthcare Provider Details

I. General information

NPI: 1558678466
Provider Name (Legal Business Name): WILLIAM MICHAEL GAYOWSKI MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. WILL MICHAEL GAYOWSKI

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 COUNTY CENTER DR # A
SANTA ROSA CA
95403-3004
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 210
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-321-9876
  • Fax:
Mailing address:
  • Phone: 707-565-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: