Provider Demographics
NPI:1124110473
Name:EATON, GAIL Z (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:Z
Last Name:EATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 WINROW RD
Mailing Address - Street 2:
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-5080
Mailing Address - Country:US
Mailing Address - Phone:520-533-9200
Mailing Address - Fax:520-533-5246
Practice Address - Street 1:1858 PASEO SAN LUIS STE D
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5825
Practice Address - Country:US
Practice Address - Phone:520-255-1803
Practice Address - Fax:520-458-3605
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW113421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ49434Medicare UPIN
AZ104628Medicare ID - Type UnspecifiedMEDICARE
AZQ49434Medicare UPIN