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General NPI Number Information
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NPI Number | 1003209479
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Entity Type | Organization
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Legal Business Name | GATEWAY MARRIAGE AND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 690 E WARNER RD BLDG 10, STE# 152
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City | GILBERT
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State | AZ
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Zip | 85296-3054
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Country | US
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Telephone | 480-420-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 690 E WARNER RD BLDG 10, STE# 152
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City | GILBERT
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State | AZ
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Zip | 85296-3054
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Country | US
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Telephone | 480-420-7061
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | CALLEEN ANTOINETTE MORRIS
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Credential | MAS-MFT, LMFT
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Telephone | 480-268-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-10408
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License Number State | AZ
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