Individual
ELIZABETH R GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
631 W WILLOW AVE, VISALIA, CA 93291-6101
(559) 738-0800
(559) 738-0800
Mailing address
4125 W NOBLE AVE, PMB 315, VISALIA, CA 93277-1662
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
015598-1
NY
103TC0700X
Clinical Psychologist
Primary
PSY14743
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49550
FRESNO COUNTY VENDOR ID
CA
01
—
518693
VALUE OPTIONS
CA
05
—
PSY147430
—
CA
Enumeration date
04/18/2007
Last updated
07/09/2007
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