Provider Demographics
NPI:1114303849
Name:IRWIN, GAIL MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:MARIE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W SIDLEE ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3241
Mailing Address - Country:US
Mailing Address - Phone:805-217-8677
Mailing Address - Fax:
Practice Address - Street 1:39 W SIDLEE ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3241
Practice Address - Country:US
Practice Address - Phone:805-217-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist