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General NPI Number Information
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NPI Number | 1912207267
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Entity Type | Organization
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Legal Business Name | GATE OF RECOVERY, INC.
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 123 HODENCAMP RD SUITE 205
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5896
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Country | US
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Telephone | 805-777-7595
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Fax | 805-777-9249
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Provider Business Mailing Address
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Address Line | 123 HODENCAMP RD SUITE 205
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5896
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Country | US
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Telephone | 805-777-7595
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Fax | 805-777-9249
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Authorized Official
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Title or Position | CEO
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Name | MINOO SHILATI
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Credential | LMFT
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Telephone | 805-777-7595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LMFT 45424
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT#45424
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 560045AP
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 560045AP
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License Number State | CA
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