Basic Information
| Provider Information | |||||||||
| NPI: | 1306356969 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATAPIA | ||||||||
| FirstName: | MARY GRACE ANTONETTE | ||||||||
| MiddleName: | ABEAR | ||||||||
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| Credential: | MFTI, PPCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8421 AUBURN BLVD. BLDG #3 | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Practice Location | |||||||||
| Address1: | 8421 AUBURN BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2017 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 10/11/2017 | ||||||||
| NPIReactivationDate: | 10/18/2017 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF100848 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.