Provider Demographics
NPI:1710136916
Name:GLADSTONE COUNSELING CENTER
Entity Type:Organization
Organization Name:GLADSTONE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WHYDDON
Authorized Official - Last Name:GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-646-9724
Mailing Address - Street 1:530 W OJAI AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2462
Mailing Address - Country:US
Mailing Address - Phone:805-646-9724
Mailing Address - Fax:805-646-1387
Practice Address - Street 1:530 W OJAI AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2462
Practice Address - Country:US
Practice Address - Phone:805-646-9724
Practice Address - Fax:805-646-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6173103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6173Medicare PIN