Healthcare Provider Details

I. General information

NPI: 1366200099
Provider Name (Legal Business Name): GATEWOOD THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N ASH ST
TRUTH OR CONSEQUENCES NM
87901-1822
US

IV. Provider business mailing address

548 MARKET ST PMB 22932
SAN FRANCISCO CA
94104-5401
US

V. Phone/Fax

Practice location:
  • Phone: 415-212-8685
  • Fax:
Mailing address:
  • Phone: 415-212-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARTHOLOMEW KOVACS
Title or Position: FOUNDER
Credential: LMFT
Phone: 415-212-8685