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General NPI Number Information
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NPI Number | 1295879401
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Entity Type | Individual
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Provider Name | GALE MARIE AUDIA M.F.T
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1250 E WALNUT ST SUITE 110
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City | PASADENA
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State | CA
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Zip | 91106-1893
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Country | US
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Telephone | 626-794-9426
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Fax |
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Provider Business Mailing Address
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Address Line | 2037 JEFFERSON DR
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City | PASADENA
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State | CA
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Zip | 91104-1732
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Country | US
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Telephone | 626-794-9426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MFT20757
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License Number State | CA
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