Provider Demographics
NPI:1134643349
Name:SEESE, GAYLE SEESE (MFT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:SEESE
Last Name:SEESE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:10660 JAMES LANE
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 SACRAMENTO ST STE 205
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2633
Practice Address - Country:US
Practice Address - Phone:530-559-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-29
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist