Provider Demographics
NPI:1538292115
Name:GERNANDT, DEBRA JOANN EVANS (50395 MFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOANN EVANS
Last Name:GERNANDT
Suffix:
Gender:F
Credentials:50395 MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:SANTA YSABEL
Mailing Address - State:CA
Mailing Address - Zip Code:92070-0231
Mailing Address - Country:US
Mailing Address - Phone:760-765-3578
Mailing Address - Fax:760-765-2810
Practice Address - Street 1:30240 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:SANTA YSABEL
Practice Address - State:CA
Practice Address - Zip Code:92070
Practice Address - Country:US
Practice Address - Phone:760-765-3578
Practice Address - Fax:760-765-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50395106H00000X
CA50395 MFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist