Provider Demographics
NPI:1891902953
Name:GITANE, UNKNOWN (PHD MFT 15287)
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:GITANE
Suffix:
Gender:F
Credentials:PHD MFT 15287
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 PORTAGE BAY E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-758-3949
Mailing Address - Fax:530-758-3949
Practice Address - Street 1:2657 PORTAGE BAY E
Practice Address - Street 2:SUITE 6
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-758-3949
Practice Address - Fax:530-758-3949
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist