1992867881 NPI number — DR. KARLA S GATES PHD

Table of content: DR. KARLA S GATES PHD (NPI 1992867881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992867881 NPI number — DR. KARLA S GATES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATES
Provider First Name:
KARLA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHOKMAN GATES
Provider Other First Name:
KARLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992867881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6840 INDIANA AVE, SUITE 240
Provider Second Line Business Mailing Address:
PATHWAYS COUNSELING CENTER
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92506-4298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-369-7288
Provider Business Mailing Address Fax Number:
951-369-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6840 INDIANA AVE, SUITE 240
Provider Second Line Business Practice Location Address:
PATHWAYS COUNSELING CENTER
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-4298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-369-7288
Provider Business Practice Location Address Fax Number:
951-369-1064
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY12322 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 175708 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60591273 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109886000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: OPL123220 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".