Provider Demographics
NPI:1255353793
Name:THAUBERGER, GERALD (MS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:THAUBERGER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 LAKE WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9592
Mailing Address - Country:US
Mailing Address - Phone:530-615-4570
Mailing Address - Fax:530-615-4570
Practice Address - Street 1:1095 STAFFORD WAY STE E
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3333
Practice Address - Country:US
Practice Address - Phone:530-615-4570
Practice Address - Fax:530-615-4570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC1855101YP2500X
CALMFT33242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional