Healthcare Provider Details

I. General information

NPI: 1851448450
Provider Name (Legal Business Name): JEFFERY GEHRING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S E ST SUITE 200
SANTA ROSA CA
95404-4777
US

IV. Provider business mailing address

1819 CHAPMAN LN
PETALUMA CA
94952-1620
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-5537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: