MEDICARE: SETH MICHAEL GANS 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	146642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538626320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH MICHAEL GANS LMFT

Provider Business Mailing Address
First Line	:	735 HOSKA DR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2840
Country	:	US
Telephone Number	:	858-353-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	5405 MOREHOUSE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4722
Country	:	US
Telephone Number	:	858-367-9890
Fax Number	:

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	05/30/2024

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