Provider Demographics
NPI:1922200674
Name:GABLE, DONNA TULLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:TULLY
Last Name:GABLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:310-453-8697
Mailing Address - Fax:310-264-1968
Practice Address - Street 1:3201 WILSHIRE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2335
Practice Address - Country:US
Practice Address - Phone:310-453-8697
Practice Address - Fax:310-264-1968
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical