Provider Demographics
NPI:1962687632
Name:GOMBOS, EMILY R (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:GOMBOS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST
Mailing Address - Street 2:STE 130
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2731
Mailing Address - Country:US
Mailing Address - Phone:714-323-8434
Mailing Address - Fax:949-756-9998
Practice Address - Street 1:1000 QUAIL ST
Practice Address - Street 2:STE 130
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2731
Practice Address - Country:US
Practice Address - Phone:714-323-8434
Practice Address - Fax:949-756-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist