MEDICARE: STACEY E GAITAN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF103534	CA
2	106H00000X	Marriage & Family Therapist	LMFT128452	CA

General Provider Information

NPI Number	:	1023425394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY E GAITAN LMFT

Provider Business Mailing Address
First Line	:	27200 TOURNEY RD STE 175
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4986
Country	:	US
Telephone Number	:	818-398-4298
Fax Number	:

Provider Business Practice Location Address
First Line	:	27200 TOURNEY RD STE 175
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91355-4986
Country	:	US
Telephone Number	:	661-705-4670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2025

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