Provider Demographics
NPI:1851502447
Name:GILSON, GWYNNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GWYNNE
Middle Name:
Last Name:GILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 VILLAGE PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2448
Mailing Address - Country:US
Mailing Address - Phone:925-236-0826
Mailing Address - Fax:
Practice Address - Street 1:6400 VILLAGE PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2448
Practice Address - Country:US
Practice Address - Phone:925-236-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #47835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist