Provider Demographics
NPI:1013083070
Name:BARDIN, GAIL C (LMFT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:C
Last Name:BARDIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:C
Other - Last Name:BENSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0452
Mailing Address - Country:US
Mailing Address - Phone:858-342-6564
Mailing Address - Fax:
Practice Address - Street 1:42222 RANCHO LAS PALMAS DR # 452
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:858-342-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist