Provider Demographics
NPI:1104839588
Name:WILLS, GAIL ALISON (MFT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ALISON
Last Name:WILLS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KETA
Other - Middle Name:RAE
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:2625 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4829
Mailing Address - Country:US
Mailing Address - Phone:707-441-4954
Mailing Address - Fax:707-444-1498
Practice Address - Street 1:2625 WILSON ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4829
Practice Address - Country:US
Practice Address - Phone:707-441-4954
Practice Address - Fax:707-444-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist