Provider Demographics
NPI:1497361547
Name:GOMEZ, GABRIELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:GOMEZ
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 1:11423 187TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5657
Mailing Address - Country:US
Mailing Address - Phone:877-538-4133
Mailing Address - Fax:
Practice Address - Street 1:11423 187TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5657
Practice Address - Country:US
Practice Address - Phone:877-538-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist