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General NPI Number Information
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NPI Number | 1750658233
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Entity Type | Individual
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Provider Name | RANDALL GATES MFT
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Gender | Male
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 16542 VENTURA BLVD SUITE 320
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City | ENCINO
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State | CA
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Zip | 91436-2005
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Country | US
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Telephone | 310-422-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 333 OHIO ST NONE
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City | PASADENA
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State | CA
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Zip | 91106-4211
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Country | US
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Telephone | 310-422-7101
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC 50209
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License Number State | CA
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