Provider Demographics
NPI:1962066142
Name:GUBSA, HELEN GEBRETENSAI
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:GEBRETENSAI
Last Name:GUBSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WOODWARDIA SQ
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5328
Mailing Address - Country:US
Mailing Address - Phone:707-708-6776
Mailing Address - Fax:
Practice Address - Street 1:8 WOODWARDIA SQ
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5328
Practice Address - Country:US
Practice Address - Phone:707-708-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst