Provider Demographics
NPI:1982125381
Name:ANDERSON, GABRIEL ANDREW (MAED, LPCC, AMFT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANDREW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MAED, LPCC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25000 CENTER RIDGE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4105
Mailing Address - Country:US
Mailing Address - Phone:440-892-7034
Mailing Address - Fax:440-815-2095
Practice Address - Street 1:2684 RADIO LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4232
Practice Address - Country:US
Practice Address - Phone:530-245-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131868106H00000X
OHE.2102511101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor