Provider Demographics
NPI:1467579813
Name:MICHAEL GASS, PH.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL GASS, PH.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:THE REBUILDING THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-462-0102
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-462-0102
Mailing Address - Fax:949-462-0124
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 290
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-462-0102
Practice Address - Fax:949-462-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#PSY5201103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty