Provider Demographics
NPI:1033964002
Name:SHURTLEFF, GAIL (MA, MFT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:SHURTLEFF
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 TOTTENHAM CT
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4732
Mailing Address - Country:US
Mailing Address - Phone:209-232-4246
Mailing Address - Fax:
Practice Address - Street 1:HERIK 5
Practice Address - Street 2:
Practice Address - City:HUIZEN
Practice Address - State:HOLLAND
Practice Address - Zip Code:1274AW
Practice Address - Country:NL
Practice Address - Phone:209-232-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
38078106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist