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Organization
SEQUOIA BEHAVIORAL HEALTH
Active
Organization
SEQUOIA BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY ANN GAUNTLETT PSY.D. (EXECUTIVE DIRECTOR)
(415) 317-2343
Entity
Organization
Contact information
Practice address
10 JACKSON CT, NOVATO, CA 94947-5532
(415) 317-2343
Mailing address
10 JACKSON CT, NOVATO, NOVATO, CA 94947-5532
(415) 317-2343
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY23692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154638740
MEDI-CAL
CA
Enumeration date
09/05/2012
Last updated
09/05/2012
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