Provider Demographics
NPI:1659595239
Name:LOOMIS, GAIL L (MFT)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:L
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE H-186
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3901
Mailing Address - Country:US
Mailing Address - Phone:408-554-6400
Mailing Address - Fax:408-942-0437
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE H-186
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-554-6400
Practice Address - Fax:408-942-0437
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist