Provider Demographics
NPI:1225226434
Name:GILBERT, JOHN M (MA, LMFT, CHT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MA, LMFT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95612-5070
Mailing Address - Country:US
Mailing Address - Phone:661-310-6648
Mailing Address - Fax:
Practice Address - Street 1:4396 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:CA
Practice Address - Zip Code:95612-5070
Practice Address - Country:US
Practice Address - Phone:661-310-6648
Practice Address - Fax:661-940-5452
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37413101YA0400X, 101YP2500X, 106H00000X
101YP1600X, 225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37413OtherBBSE
14407150OtherCAQH