Provider Demographics
NPI:1861508418
Name:BUNKER, GAIL FAZACKERLEY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:FAZACKERLEY
Last Name:BUNKER
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 1:30100 MISSION BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544
Mailing Address - Country:US
Mailing Address - Phone:510-475-5555
Mailing Address - Fax:
Practice Address - Street 1:30100 MISSION BLVD
Practice Address - Street 2:STE 1
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-475-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist