Provider Demographics
NPI:1184253908
Name:TAMPLIN, GINA ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ELIZABETH
Last Name:TAMPLIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3017
Mailing Address - Country:US
Mailing Address - Phone:602-405-3142
Mailing Address - Fax:
Practice Address - Street 1:1100 S LAMAR BLVD APT 1413
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-0198
Practice Address - Country:US
Practice Address - Phone:323-577-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist