Provider Demographics
NPI:1578315156
Name:CANTON, GAYLE ALLISON (MFT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ALLISON
Last Name:CANTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:ALLISON
Other - Last Name:OSDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:488 GREEN GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4018
Mailing Address - Country:US
Mailing Address - Phone:415-516-3061
Mailing Address - Fax:
Practice Address - Street 1:488 GREEN GLEN WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4018
Practice Address - Country:US
Practice Address - Phone:415-516-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT24074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health