MEDICARE: GALE MITCHELL MFT

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	#MFC41939	CA

General Provider Information

NPI Number	:	1306015854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALE MITCHELL MFT

Provider Business Mailing Address
First Line	:	2515 SANTA CLARA AVE
Second Line	:	#210
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4660
Country	:	US
Telephone Number	:	510-334-0195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 SANTA CLARA AVE
Second Line	:	#210
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4660
Country	:	US
Telephone Number	:	510-334-0195
Fax Number	:

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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Directions to “ GALE MITCHELL MFT” Practice Location

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