Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MFC 37413 | CA |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | MFC 37413 | CA |
NPI | 1225226434 |
---|---|
Provider Name | John M Gilbert |
First Address | Clarksburg, CA 95612-5070 |
Second Address | Clarksburg, CA 95612-5070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 30/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14407150 | CAQH (01) | |
37413 | BBSE (01) | CA |