Provider Demographics
NPI:1699708404
Name:EISELMAN, GAIL SUE (LMFT)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:SUE
Last Name:EISELMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PARK WAY
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3928
Mailing Address - Country:US
Mailing Address - Phone:510-653-6111
Mailing Address - Fax:510-653-7267
Practice Address - Street 1:49 PARK WAY
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-3928
Practice Address - Country:US
Practice Address - Phone:510-653-6111
Practice Address - Fax:510-653-7267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health