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General NPI Number Information
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NPI Number | 1366200099
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Entity Type | Organization
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Legal Business Name | GATEWOOD THERAPY LLC
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 815 N ASH ST
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City | TRUTH OR CONSEQUENCES
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State | NM
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Zip | 87901-1822
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Country | US
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Telephone | 415-212-8685
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MARKET ST PMB 22932
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5401
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Country | US
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Telephone | 415-212-8685
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | BARTHOLOMEW KOVACS
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Credential | LMFT
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Telephone | 415-212-8685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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