Provider Demographics
NPI:1962826867
Name:WARREN, GAYLE (MS)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8272 MEDEIROS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8163
Mailing Address - Country:US
Mailing Address - Phone:916-681-7038
Mailing Address - Fax:
Practice Address - Street 1:3000 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1831
Practice Address - Country:US
Practice Address - Phone:916-483-2154
Practice Address - Fax:916-483-2850
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCI 288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health