Provider Demographics
NPI:1942740790
Name:CAREY, GAELLE (LMFT #123162)
Entity Type:Individual
Prefix:
First Name:GAELLE
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:LMFT #123162
Other - Prefix:
Other - First Name:GAELLE
Other - Middle Name:I
Other - Last Name:VIRIOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT #123162
Mailing Address - Street 1:3111 CAMINO DEL RIO N STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5724
Mailing Address - Country:US
Mailing Address - Phone:619-852-4998
Mailing Address - Fax:
Practice Address - Street 1:730 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6618
Practice Address - Country:US
Practice Address - Phone:619-852-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106286106H00000X
CA123162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942740790OtherCALIFORNIA