Provider Demographics
NPI:1073662128
Name:GAAB, LARRY M (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:M
Last Name:GAAB
Suffix:
Gender:M
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 1:55 INDEPENDENCE CIR STE 111
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4909
Mailing Address - Country:US
Mailing Address - Phone:530-342-0460
Mailing Address - Fax:
Practice Address - Street 1:55 INDEPENDENCE CIR STE 111
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4909
Practice Address - Country:US
Practice Address - Phone:530-342-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT12198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist