Provider Demographics
NPI:1558678466
Name:GAYOWSKI, WILLIAM MICHAEL (MFT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:GAYOWSKI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:WILL
Other - Middle Name:MICHAEL
Other - Last Name:GAYOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2227 CAPRICORN WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5486
Mailing Address - Country:US
Mailing Address - Phone:707-565-6672
Mailing Address - Fax:
Practice Address - Street 1:2400 COUNTY CENTER DR # A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3004
Practice Address - Country:US
Practice Address - Phone:707-321-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83696106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor