Provider Demographics
NPI:1508904178
Name:GALE, JAY (PHD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:GALE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 S POINTE DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1547
Mailing Address - Country:US
Mailing Address - Phone:949-586-6690
Mailing Address - Fax:949-586-8508
Practice Address - Street 1:23461 S POINTE DR
Practice Address - Street 2:SUITE 190
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:949-586-6690
Practice Address - Fax:949-586-8508
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical