Provider Demographics
NPI:1003209479
Name:GATEWAY MARRIAGE AND FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:GATEWAY MARRIAGE AND FAMILY THERAPY, LLC
Other - Org Name:GATEWAY MFT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CALLEEN
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MAS-MFT, LMFT
Authorized Official - Phone:480-268-4327
Mailing Address - Street 1:690 E WARNER RD
Mailing Address - Street 2:BLDG 10, STE# 152
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3054
Mailing Address - Country:US
Mailing Address - Phone:480-420-7061
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD
Practice Address - Street 2:BLDG 10, STE# 152
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3054
Practice Address - Country:US
Practice Address - Phone:480-420-7061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty