Provider Demographics
NPI:1720152135
Name:GOULD, TOBY (MFT)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SYCAMORE DR
Mailing Address - Street 2:SUITE #19
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2910
Mailing Address - Country:US
Mailing Address - Phone:925-906-8938
Mailing Address - Fax:510-526-8354
Practice Address - Street 1:2400 SYCAMORE DR
Practice Address - Street 2:SUITE #19
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2910
Practice Address - Country:US
Practice Address - Phone:925-906-8938
Practice Address - Fax:510-526-8354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT22924106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist